Screening Decisions Research Articles

Machine learning-assisted literature screening for a medication-use process-related systematic review.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This article summarizes a novel methodology of applying machine learning (ML) algorithms trained with external training data to assist with article screening for 2 annual review series related to the medication-use process (MUP) generally and the MUP in ambulatory care settings (ACMUP) specifically. As the literature review for these 2 series grew over time, it became essential for the authors to develop methods to be efficient while still capturing most of the relevant literature. The ML model can be used to predict whether search results are likely to be relevant or not relevant. Results least likely to be relevant can then be excluded without manual screening, allowing research teams to save time that would otherwise be spent reviewing a portion of the search results for inclusion. ML models require a large training dataset typically derived from the unclassified corpus. In this study, the authors demonstrate the efficacy of training the ML model using external training data, which is possible in scenarios such as a systematic review update or ongoing review series such as those for the MUP and ACMUP. The authors ran 3 simulations using screening decisions from previous publications and in-process manuscripts for the MUP and ACMUP review series to test the efficacy of the approach. The simulations were compared to actual manual screening decisions made by the research teams to include or exclude articles using title and abstract text. For each simulation, the authors developed a training dataset using a sample of screening decisions from previous years to predict article relevance in an "unclassified" corpus. In this case, the screening decisions for the unclassified corpus were actually known, allowing us to calculate recall (percent of relevant articles captured) and time saved using the number of articles that would be excluded without manual review. Combined, the ML approach correctly labeled 187 of 192 relevant studies. The 3 simulations included 17,227 unique studies, and using ML the authors demonstrated that 13,201 studies could have been excluded without manual screening while still maintaining recall of relevant articles of 95% or greater. This novel approach is applicable to systematic reviews and ongoing review series, including those for the MUP and ACMUP. Pharmacists have a duty to review and incorporate best practices into their organizations to improve the efficiency and cost of care, optimally utilize technology, and reduce the potential for medication errors. This methodology will allow evidence syntheses for the MUP and other disciplines in pharmacy practice to be published more expeditiously by saving significant time during the article screening step.

Predicting risk of tuberculosis disease in people migrating to a low-TB incidence country: development and validation of a multivariable dynamic risk prediction model using health administrative data.

Tuberculosis (TB) incidence remains disproportionately high in people migrating to Canada and other low TB incidence countries, but systematic TB screening and prevention in migrants is often cost-prohibitive for TB programs. We aimed to develop and validate a TB risk prediction model to inform TB screening decisions in foreign-born permanent residents of Canada. We developed and validated a proportional baselines landmark supermodel for TB risk prediction using health administrative data from British Columbia and Ontario, two distinct provincial healthcare systems in Canada. Demographic (age, sex, refugee status, year of entry, TB incidence in country of origin), TB exposure, and medical (HIV, kidney disease, diabetes, solid organ transplantation, cancer) covariates were used to derive and test models in British Columbia; one model was chosen for external validation in the Ontario cohort. The model's ability to predict 2- and 5-year TB risk in the Ontario cohort was assessed using discrimination and calibration statistics. The study included 715,423 individuals (including 1,407 people with TB disease) in the British Columbia derivation cohort, and 958,131 individuals (including 1,361 people with TB disease) in the Ontario validation cohort. The 2- and 5-year concordance statistic in the validation cohort was 0.77 (95%CI: 0.75-0.78) and 0.77 (95%CI: 0.76-0.78), respectively. Calibration-in-the-large values were 0.14 (95% CI: 0.08-0.21) and -0.05 (95% CI: -0.12-0.02) in 2- and 5-year prediction windows. This prediction model, available online at https://tb-migrate.com, may improve TB risk stratification in people migrating to low incidence countries and may help inform TB screening policy and guidelines.

Base Rates of Non‐Proficiency in Reading and Math: Implications for Universal Screening

ABSTRACTSeveral researchers have called for schools to interpret universal screening results using posterior probabilities. Following this recommendation could require schools to move away from direct‐route, single‐measure screening unless base rates of risk fall within a narrow range. In this descriptive study, we investigated two questions surrounding the feasibility of adopting a probability‐based approach in schools. First, how many districts had base rates of risk that would allow educators to classify all students using a single screener? Second, to what extent would yearly fluctuation in base rates require planned flexibility in screening procedures? We used public state test data to estimate base rates of risk for each district in Florida, Oregon, and Wisconsin across four school years. Districts' base rates of risk were rarely within the required range for a single screener to classify all students based on posterior probabilities. Many districts had base rates conducive to direct route screening in at least 1 year but very few had base rates in the required zone across the 4 years. Using posterior probabilities to make screening decisions may require more changes to existing practices than simply interpreting screening results as probabilities. Additional research to promote the use of this approach in schools is needed.

Pearls for counseling older adults on the indications for stopping colon cancer screening

Colorectal cancer remains a leading cause of mortality, making effective screening procedures like colonoscopy essential in reducing associated risks. The cessation of colorectal cancer screening in older adults presents complex challenges, particularly as guidelines recommend screening initiation at age 45 and emphasize individualized decision-making for older populations. Key considerations include balancing procedural risks, cancer risk, overall health prognosis, and patient preferences. The risks associated with colonoscopy are especially pertinent for older patients with comorbidities, necessitating the use of prognostic tools like ePrognosis and the Charlson Comorbidity Index to inform screening decisions. High-risk individuals may experience increased anxiety about cancer, complicating the decision-making process, as many have historically relied on regular surveillance. Perspectives from both physicians and patients reveal significant uncertainty regarding screening cessation, highlighting the importance of patient involvement in these discussions. Effective communication strategies are crucial, advocating for recommendations that align with patients' broader health goals rather than focusing solely on age-related actuarial data. Ultimately, navigating the intricacies of colorectal cancer screening cessation in older adults requires a patient-centered approach that minimizes risks while respecting individual values and health goals.

Improving peripheral artery disease screening and treatment: a screening, diagnosis, and treatment tool for use across multiple care settings.

Peripheral artery disease (PAD) is an atherosclerotic disease that contributes to significant morbidity and mortality, including loss of limb, myocardial infarction (MI), stroke, and death. Treatment options are often underutilized. A major limiting factor in PAD care is the ability to efficiently identify and screen at-risk patients. A PAD patient screening and clinician decision support tool was created to improve access to high-quality, evidence-based care to drive improved clinical outcomes. The tool identifies known PAD risk factors and presenting symptoms, in combination with objective data obtained via the ankle-brachial index (ABI). The tool utilizes this data to drive PAD diagnosis, risk assessment, and treatment, and it is adaptable across multiple care settings, by varied health professions. The implementation of a PAD screening and treatment toolkit enhances anticoagulation and PAD stewardship, and it has been integrated into use across various care settings.

Development of a risk-stratified shared decision-making tool for colorectal cancer screening

Abstract European guidelines stress the importance of informed decision-making in colorectal cancer (CRC) screening. However, tailored tools that facilitate decision-making for underserved people and general practitioners (GPs) in Flanders are lacking. This study aimed to develop a tailored shared decision-making (SDM) tool for CRC screening, specifically a video decision aid, using a co-creative process. The development involved two rounds of focus group discussions with underserved people and five local quality group meetings with GPs in various parts of Flanders, Belgium. Qualitative data were analyzed using a Modified-Grounded Theory Analytical (M-GTA) approach to identify key themes. Findings revealed four core themes. The first theme, ‘Recognizing the Barriers to Screening’, identifies challenges such as a lack of time, staff, and tools for GPs, as well as language and literacy barriers for underserved people. The second theme, ‘Learning from Existing Tools’, highlights successful elements like visuals and simple language and limitations such as low accessibility and poor navigation. The third theme, ‘Determining the Content and Design,’ reveals that GPs seek user-friendly tools for at-home viewing, while underserved people value personalized and clear information about CRC risk factors and screening costs. The final theme, ‘Identifying Strategies for Integration,’ stresses the importance of a structured, collaborative care approach for the successful integration of the tool. The proposed modifications for the SDM tool include enhancing its accessibility with multiple language options, using simple and relatable visuals, and providing personalized risk discussions for underserved people and GPs. Nonetheless, further testing is needed to confirm the effectiveness of the SDM tool in supporting preventive talks and informed decision-making in CRC screening among these target groups. Key messages • A structured, collaborative care approach is needed for successful SDM tool integration during preventive talks with underserved people. • Further testing is needed to confirm the tool’s effectiveness in supporting informed decision-making in CRC screening for underserved people.

Why do older adults stop cancer screening? Findings from the Medicare Current Beneficiary Survey.

Prostate and breast cancer screening are prevalent among older adults, even among those unlikely to benefit. We aimed to evaluate why older adults stop cancer screening, including the role of physician recommendations. We used nationally representative data from the 2019 Medicare Current Beneficiary Survey (MCBS). We included women aged 76 and older without a history of breast cancer and men aged 71 and older without a history of prostate cancer. The primary outcome was reason for discontinuing screening, categorized as follows: (1) physician recommendation against screening; (2) absence of a recommendation to screen; and (3) patient-driven reason, such as patient preferences or beliefs. We evaluated reasons for screening discontinuation by health status and educational attainment using age-stratified multinomial logistic regression. The sample included 7350 participants representing a weighted population of 22,498,715. Overall, 53% of women underwent screening mammography in the past year or intended to continue screening. Among those who stopped screening, 5% reported a recommendation to stop screening from their doctor, 48% reported no recommendation, and 32% reported a patient-driven reason for cessation. Findings did not differ by educational attainment or health status, including among the oldest patients. For men, 61% were screened with PSA in the past year or intended to continue. Among those who stopped, 3% reported a recommendation against screening, 54% reported no recommendation, and 27% reported a patient-driven reason for cessation. Men with higher educational attainment were more likely to report that their physician recommended against screening (4% vs. 1%, p = 0.01) and that their doctor did not recommend screening (58% vs. 47%, p = 0.01). Reasons for screening cessation did not differ by health status, including among the oldest patients. Cancer screening remains common, even among those with limited potential for benefit, but discussions around screening cessation are rare. Improving communication between patients and physicians may improve screening decision quality.

The TELEhealth Shared decision-making COaching and navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators.

Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching and navigationintervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm. Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching and navigationsession about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods. We will assess whether a decision coaching and patient navigation intervention can feasibly and effectivelysupport high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations. This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022. Version 1, April 10, 2024.

Enhancing Early Detection of Prostate Cancer Using PSA-Guided Screening in High-Risk Men Under 50

Abstract Background Prostate Cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines, including those by the USPSTF, ACS and ASCO offer varying recommendations on PSA screening. Present clinical practice, primarily targeting men aged 50-69. Our study aimed to assess the feasibility and validity of using PSA for targeted screening in men under 50 who are at high risk, enhancing early detection of prostate cancer. Methods This retrospective analysis utilized data from our hospital’s prostate cancer screening program collected from 2022 to 2023, including104 individuals under 50. Participants were categorized based on PSA levels 4-10 ng/mL (n=71) and over10 ng/mL (n=33). We analyzed the number of cases diagnosed with prostate cancer and the correlation with PSA levels, Gleason Scores (GS), family history, and ethnicity/race. Results In the104 participants, 88 of them were diagnosed with prostate cancer, highlighting an 84.6% detection rate. Among PSA levels 4-10 ng/mL group, 36 out of 43 White or Caucasian and 13 out of 13 Black or African American men were identified as GS 6-10. In the group PSA over 10 ng/mL, 18 White or Caucasian and 6 Black or African American individuals with more aggressive disease (GS 6-10). Importantly, a substantial fraction of these cases had a first-degree relative with prostate cancer, emphasizing the influence of family history on PSA screening decision. Conclusion Our findings suggest that PSA-guided screening in men under 50 at high risk can enhance the early detection of prostate cancer. The significant presence of intermediate-risk prostate cancer (GS 6 or 7) in populations at higher risk due to ethnicity/race and family history. Our study highlights the potential benefits of revisiting current screening guidelines to lower the age threshold for high-risk populations.

Medical Maximizing Orientation and the Desire for Low-Value Screening: An Examination of Mediating Mechanisms.

Medical maximizing orientation is a stable, traitlike inclination to actively use health care, often associated with pursuing low-value care. Despite attempts to reduce the overuse of low-value care by targeting this orientation directly, such interventions have not always been effective. To design effective interventions to reduce the overuse of low-value care, it is critical to understand the underlying mechanisms that govern the impact of medical maximizing orientation. To examine whether risk perception (deliberative, affective, and experiential) and knowledge of the benefits and harms of low-value screening mediate the potential impact of medical maximizing orientation on attitudes toward screening uptake and screening decisions. A secondary analysis was conducted on data from a Web-based experiment examining various communication tactics in an information booklet regarding low-value thyroid ultrasonography among South Korean women (N = 492). Multiple linear, zero-inflated negative binomial and multinomial logistic regressions were used to examine the relationships between medical maximizing orientation and other study variables. A mediation analysis was performed to test mediating mechanisms. Medical maximizing orientation was associated with an increased positive attitude toward screening uptake and a lower likelihood of deciding not to get screened or being uncertain regarding screening decisions (relative to deciding to get screened). Knowledge and affective risk perception partially mediated the relationship between medical maximizing orientation and positive attitudes. Knowledge, deliberative, and affective risk perceptions partially mediated the relationship between medical maximizing orientation and the screening decision. Interventions should prioritize targeting more amenable factors arising from medical maximizing orientation, such as inflated risk perceptions, particularly affective risk perception, and limited comprehension or acceptance of information about the benefits and risks associated with low-value care. This study demonstrated that people's medical maximizing orientation can increase their positive attitudes toward the uptake of low-value screening and make them more likely to undergo it. This can happen both directly and indirectly by decreasing their understanding of the benefits and risks of screening and increasing their perception of disease risk.The study suggests that to effectively mitigate the excessive utilization of low-value care through patient-centered interventions, it is crucial to tackle 2 key issues associated with a medical maximizing mindset: inflated risk perceptions (specifically affective risk perception) and limited comprehension or acceptance of information about the benefits and risks of low-value care.This study contributes to developing a theoretical framework for interventions to improve evidence-based medical decision making by uncovering one mechanism by which medical maximizing orientation may affect the propensity to seek low-value care.

Defining sensitivity and specificity for quality control of organized cancer screening using Prefectural Cancer Registry data in Japan

Objective To decrease cancer mortality by implementing cancer screening programs, rigorous quality control measures that utilize standardized indicators are imperative. In Japan, although each municipality performing cancer screening programs implements quality control for their programs using the checklist authorized by the Ministry of Health, Labour and Welfare, compliance with all the items listed is not possible because calculating sensitivity and specificity using cancer registry data is difficult under these circumstances. This report elucidates the methodology for calculating indicators, including sensitivity and specificity, by delineating the parameters of false-negative cases within population-based cancer screening programs in Japan. Furthermore, the inherent challenges associated with ensuring the quality control of cancer screening procedures are expounded upon in this report.Method Data from the Prefectural Cancer Registry of Japan and cancer screening records compiled by municipalities were used to differentiate true-positive, true-negative, false-positive, and false-negative cases based on the combination of screening test outcomes and subsequent cancer incidence.Results A false-negative case was defined as an examinee who received a cancer diagnosis within one year after undergoing the screening test, notwithstanding the negative judgment of the cancer screening decision. The duration for judgment of true-positive, true-negative, and false-negative cases was also extended to one year. Cancer identification after cancer screening was ascertained using data from the Prefectural Cancer Registry, ensuring uniform categorization of the four cases. Subsequently, sensitivity and specificity values were calculated for municipalities conducting cancer screening programs.Conclusion Sensitivity and specificity are indispensable metrics for the inherent quality control of cancer screening because these parameters directly assess the efficacy of screening tests. The anticipated increase in the number of municipalities engaged in comprehensive quality control of cancer screening in Japan is poised to enhance the efficiency of cancer control policies. This augmentation will be accomplished through the meticulous utilization of the sensitivity and specificity values elucidated in the present report. The forthcoming challenges involve the proliferation of medical institutes reporting their adherence to the checklist stipulated by the National Cancer Center of Japan and the widespread dissemination of fundamental knowledge pertaining to cancer screening.

B-321 Enhancing Early Detection of Prostate Cancer Using PSA-Guided Screening in High-Risk Men Under 50

Abstract Background Prostate Cancer remains a significant global public health concern. It is the most common cancer and the second leading cause of cancer death among men in the United States. Current guidelines, including those by the USPSTF, ACS and ASCO offer varying recommendations on PSA screening. Present clinical practice, primarily targeting men aged 50-69. Our study aimed to assess the feasibility and validity of using PSA for targeted screening in men under 50 who are at high risk, enhancing early detection of prostate cancer. Methods This retrospective analysis utilized data from our hospital's prostate cancer screening program collected from 2022 to 2023, including104 individuals under 50. Participants were categorized based on PSA levels 4-10 ng/mL (n=71) and over10 ng/mL (n=33). We analyzed the number of cases diagnosed with prostate cancer and the correlation with PSA levels, Gleason Scores (GS), family history, and ethnicity/race. Results In the104 participants, 88 of them were diagnosed with prostate cancer, highlighting an 84.6% detection rate. Among PSA levels 4-10 ng/mL group, 36 out of 43 White or Caucasian and 13 out of 13 Black or African American men were identified as GS 6-10. In the group PSA over 10 ng/mL, 18 White or Caucasian and 6 Black or African American individuals with more aggressive disease (GS 6-10). Importantly, a substantial fraction of these cases had a first-degree relative with prostate cancer, emphasizing the influence of family history on PSA screening decision. Conclusions Our findings suggest that PSA-guided screening in men under 50 at high risk can enhance the early detection of prostate cancer. The significant presence of intermediate-risk prostate cancer (GS 6 or 7) in populations at higher risk due to ethnicity/race and family history. Our study highlights the potential benefits of revisiting current screening guidelines to lower the age threshold for high-risk populations.

Public’s perception and attitude toward genetic testing in Jazan region

ABSTRACT Background: With the advancements in genetic testing, a differentiated evaluation for susceptibility to diseases is becoming applicable to many disorders. Understanding the circumstances and promoting the widespread use of these tests in the Saudi setting requires understanding public opinion and attitudes. This study aimed to determine the perception and attitudes of the public in the Jazan region to genetic testing. Material and Methods: A cross-sectional survey study of 507 participants was conducted in the Jazan region. The data were collected through an online questionnaire containing demographic information and statements assessing public perceptions and attitudes. Results: Our findings showed that perspectives toward genetic testing, especially premarital and prenatal testing, are generally positive and consistent with previous research. Approximately 79.1% of the participants had a positive attitude toward supporting a compulsory governmental decision of genetic screening before marriage, and 67.3% were willing to perform such testing in the future. More than half of the participants were willing to allow pregnancy termination if there was a higher probability of genetic disease in the baby. In contrast, only 29.6% agreed with the decision to divorce due to the higher probability of genetic disease in their children. The predictors for a positive attitude to genetic testing were nationality, marital status, and monthly income. Conclusion: The results of the present study indicate that there are acceptable perspectives and attitudes toward genetic testing, especially premarital and prenatal testing.

Dissemination of colorectal cancer information among Hispanic patients and their social network

BackgroundColorectal cancer (CRC) screening decision aids can inform patients about CRC screening benefits, costs, and procedures. Patients who receive the decision aid report wanting to share the information with their families and friends. We evaluated a CRC screening decision aid on Hispanic patients’ communication to their alters and whether patient-alter communication leads to alters’ CRC screening intention.MethodsWe conducted a one-arm pre/post study of Hispanic patients and their alters; patients (n = 42) and their alters (n = 19) were recruited from a clinic site in Yakima County, Washington State. Patients viewed a CRC screening decision aid at the clinic site. Survey data from patients and alters were collected via telephone including patients’ communication with their alters about CRC screening after viewing the decision aid and alters’ intention to be screened for CRC after talking to the patient.ResultsMost participants reported sharing CRC information with their alters after viewing the decision aid, and most alters confirmed they had received CRC information from participants (68%). The decision aid was associated with participants' own intention to undergo CRC screening and with alters' intention to be screened for CRC using a fecal occult blood test (p = 0.014) and sigmoidoscopy (p = 0.011).ConclusionsPatient decision aids have the potential to increase CRC screening behavior beyond the decision aid recipients to their social network.Trial registrationTrials Registration Number: NCT04444232 “Retrospectively registered.”

Sex-Specific Cardiovascular Risk Factors and Treatment in Females With T2DM and CVD: Developments and Knowledge Gaps

Abstract Purpose There are large disparities in the impact of diabetes on cardiovascular disease (CVD) risk and outcomes by sex and gender. Achieving health equity requires understanding risks and medication efficacy in female patients, especially now, as novel pharmacologic treatments are transforming the diabetes and CVD treatment landscape. This review examines 2 bodies of research that can inform sex differences in CVD in patients with diabetes: female-specific risk factors for CVD and sex-related limitations of clinical trial research in evaluating novel diabetes and CVD treatments. Methods Two literature searches were performed using Ovid Medline(R) All. The first retrieved manuscripts covering sex and gender differences related to CVD risk and therapies and diabetes. The second focused on randomized controlled trial data on sex/gender differences and GLP-1/SGLT-2/DPP-4 drugs. Results Female-specific risk factors for CVD include early menarche, premature or early menopause, irregular cycles and polycystic ovary syndrome; pregnancy; adverse pregnancy outcomes; history of breast cancer; and autoimmune diseases. Clinical trials of novel pharmacological treatments for diabetes and CVD have undersampled female populations, and clinical characteristics of male and female participants have differed significantly. Thus, evidence to evaluate potential sex differences in treatment efficacy and side effects has been lacking. Conclusion To improve health of female patients with diabetes, sex-specific cardiovascular risk factors should be taken into account in screening and treatment decisions. Further, studies of cardiovascular and diabetes medications must ensure adequate representation by sex and report participant characteristics and outcomes by sex.

Abstract B046: Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer

Abstract As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting. Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B046.

Multifocal, multiphenotypic tumours arising from an MTOR mutation acquired in early embryogenesis.

Embryogenesis is a vulnerable time. Mutations in developmental cells can result in the wide dissemination of cells predisposed to disease within mature organs. We characterised the evolutionary history of four synchronous renal tumours from a 14-year-old girl using whole genome sequencing alongside single cell and bulk transcriptomic sequencing. Phylogenetic reconstruction timed the origin of all tumours to a multipotent embryonic cell committed to the right kidney, around 4 weeks post-conception. Biochemical and structural analysis of their shared MTOR mutation, absent from normal tissues, demonstrates enhanced protein flexibility, enabling a FAT domain hinge to dramatically increase activity of mTORC1 and mTORC2. Developmental mutations, not usually detected in traditional genetic screening, have vital clinical importance in guiding prognosis, targeted treatment, and family screening decisions for paediatric tumours.

“Mammograms are kind of my pacifier”: The cultural context of women's preference for annual mammograms in a risk-based screening cohort

Population genetic testing and risk-based screening have the potential to shift how we determine risk and screen for breast cancer. While much attention has been paid to the experiences of individuals who may be at elevated risk for breast cancer, less is known about how those at average risk make decisions about their health. Through qualitative interviews with 30 participants, we explore how those enrolled in a risk-based screening trial who are determined to be at average risk for breast cancer make screening decisions. We consider how the social context of breast health, known as ‘pink ribbon culture,’ and the pervasiveness of annual mammography as the standard of care make risk-based screening less acceptable for many participants. Risk-based screening paradigms assume that individuals will assess their risk quantitatively based on the risk models that are used. Yet, our findings demonstrate that social and cultural factors influence decision-making surrounding breast cancer screening, an important consideration when implementing risk-based screening programs. We will begin to address a gap in knowledge about how women who are told they are average risk after risk-based screening (most of the population) and recommended to screen less than annually make screening decisions.

An Assessment of the Acceptability of Cervical Cancer Education Intervention Materials Among Healthcare Providers in Ghana

Cervical cancer is currently the second leading cause of cancer death among women in Ghana. Previous studies have identified lack of awareness, lack of perceived susceptibility, and stigmatizing beliefs as significant sociocultural barriers to cervical cancer screening among Ghanaian women. The purpose of this study was to assess the acceptability of evidence and theory-based, culturally relevant cervical cancer education intervention materials among Ghanaian healthcare providers. Central-location intercept questionnaires were completed by providers (n = 60) in the Greater Accra region of Ghana. Providers reviewed a poster, an audio message, and a brief educational video. The variables assessed included the reaction to the materials, the ability of the materials to attract the attention of the intended audience, the ability of the materials to communicate the main point of the cancer education message, and the reaction to cultural characteristics of the materials. The mean age of the providers (n = 60) was 30.6 years, and the majority (70.8%) were females. Most of the providers had a positive general reaction to the poster, audio message, and video. The majority found the materials to be motivating. Most of the providers found the information in the materials to be attention-getting, interesting, useful, direct/to the point, and related to someone like them. Very few providers (5%) indicated that they were confused by the images or messages used in the materials. The culturally relevant cervical cancer education materials were acceptable to Ghanaian healthcare providers. These materials may be effective in shared decision-making for cervical cancer screening.

Health-seeking practices and prostate cancer screening decisions among black men in the United States, Nigeria, and Cameroon

Health-seeking practices are important for prostate cancer (CaP) screening and control. There is evidence of differences in the health practices of Black men (BM) worldwide; however, the comparison between BM’s health-seeking practices in the United States and those in Africa has not been fully elucidated. This study evaluates health-seeking practices and willingness to screen for CaP among BM in Nigeria, Cameroon, and their relatives in the United States. CaPTC family cohort study phase 1 data of 500 community-dwelling black men in Nigeria, Cameroon, and the United States 35 and 70 years were used. The association between health-seeking practices and willingness to screen for CaP was evaluated. The associations between health-seeking practices and the willingness to screen for CaP were evaluated. The majority (83.8%) reported no medical consultation in the last 12 months, and the country of residence did not improve physician visits (p= 0.378). Healthcare insurance coverage was more available to the United States participants (68.4%), 42.9% in Nigeria, and 16.7% in Cameroon. Overall willingness to screen, willingness for digital rectal examination, and prostate-specific antigen screening were significantly associated with the country of residence with p-values of 0.02, <0.01, and <0.01, respectively. United States participants showed more willingness to screen. Healthcare coverage was also associated with overall willingness to screen (p=0.033). The study showed that country of residence was not associated with physician consultation but was significantly associated with willingness for CaP screening and healthcare insurance coverage.