Meeting Screening Guidelines Research Articles

Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States.

IntroductionMany sociodemographic factors affect women’s ability to meet cancer screening guidelines. Our objective was to examine which sociodemographic characteristics were associated with women meeting US Preventive Services Task Force (USPSTF) guidelines for breast, cervical, and colorectal cancer screening.MethodsWe used 2018 Behavioral Risk Factor Surveillance System data to examine the association between sociodemographic variables, such as race/ethnicity, rurality, education, and insurance status, and self-reported cancer screening for breast, cervical, and colorectal cancer. We used multivariable log-binomial regression models to estimate adjusted prevalence ratios and 95% CIs.ResultsOverall, the proportion of women meeting USPSTF guidelines for breast, cervical, and colorectal cancer screening was more than 70%. The prevalence of meeting screening guidelines was 6% to 10% greater among non-Hispanic Black women than among non-Hispanic White women across all 3 types of cancer screening. Women who lacked health insurance had a 26% to 39% lower screening prevalence across screening types than women with health insurance. Compared with women with $50,000 or more in annual household income, women with less than $50,000 in annual household income had a 3% to 8% lower screening prevalence across all 3 screening types. For colorectal cancer, the prevalence of screening was 7% less among women who lived in rural counties than among women in metropolitan counties.ConclusionMany women still do not meet current USPSTF guidelines for breast, cervical, and colorectal cancer screening. Screening disparities are persistent among socioeconomically disadvantaged groups, especially women with low incomes and without health insurance. To increase the prevalence of cancer screening and reduce disparities, interventions must focus on reducing economic barriers and improving access to care.

Rising Proportion of Young Individuals With Rectal and Colon Cancer

BackgroundRecent trends have identified increasing number of young individuals with rectal and colon cancers. These individuals, who are younger than 50 years old, in most instances would not meet screening guidelines. We aimed to report the characteristics and trend of the rising proportion of young individuals being diagnosed with rectal and colon cancers at our institutions. Patients and MethodsThis study included 3381 rectal and colon cancer patients from the Mayo Clinic cancer registry from 1972 to 2017 who were diagnosed with rectal or colon cancer and who were < 50 years old. Patient and cancer characteristics are described. The Cochran-Armitage trend test was used to see if the change in percentage diagnosed at age < 50 years had a significant trend over the years. A linear regression model was fit to estimate the percentage change per year when the trend was approximately linear. ResultsThe percentage of patients diagnosed with rectal or colon cancer in different age categories over the years showed a rising trend for individuals aged < 50. Most of these tumors were distal (rectum, left-sided colon, and right-sided colon were 49.8%, 28.8%, and 21.4%, respectively). This was more so for patients < 50 diagnosed with rectal cancer, which showed a linear increase at a rate of 0.26% per year (P < .001). ConclusionOur study affirms the rising proportion of colorectal cancers found in young individuals, with a linear ongoing rise of rectal cancers in particular. This may have implications for the current screening recommendations for colorectal cancers, which are already being revised.

High Rates of Anal High-Grade Squamous Intraepithelial Lesions in HIV-Infected Women Who Do Not Meet Screening Guidelines.

Human immunodeficiency virus (HIV)-infected women have a higher burden of anal high-grade squamous intraepithelial lesions (HSIL) and anal cancer (AC) compared with HIV-uninfected women. Guidelines for AC screening in this population are heterogeneous. Here we report outcomes and risk factors for anal HSIL following implementation of universal AC screening offered to all HIV-infected women. Data from women who underwent AC screening with anal cytology from April 2009 to July 2014 were analyzed. Routine clinical data included anal and cervical cytology, demographic/behavioral data, and high-resolution anoscopy (HRA) results. We evaluated the association of cytology with HRA results, and predictors of HSIL pathology, and compared rates of HSIL pathology among women meeting screening guidelines to those who did not. Seven hundred forty-five HIV-infected women were screened with anal cytology. Thirty-nine percent had abnormal anal cytology on initial screen and 15% on secondary screen; 208 women underwent HRA following abnormal anal cytology. HSIL was found in 26% and 18% of anal biopsies following initial and secondary screening, respectively. One woman had AC. Cigarette smoking more than doubled HSIL risk. Among women who underwent AC screening despite not meeting existing guideline criteria, 21% and 10%, respectively, were found to have HSIL on biopsy. Neither meeting criteria for screening nor history of receptive anal sex was significantly associated with HSIL. Anal HSIL is common in HIV-infected women. Substantial numbers of HSIL would have been missed by strictly adhering to existing AC screening guidelines. These results support routine screening of all HIV-infected women regardless of human papillomavirus history or sexual practices.

Aboriginal and Torres Strait Islander health: accuracy of patient self‐report of screening for diabetes, high cholesterol and cervical cancer

ObjectiveTo determine the accuracy and clinical utility of patient self‐reported screening history. MethodsAboriginal and Torres Strait Islander patients (≥18 years; n=587) were interviewed on their screening history according to recommended time intervals; these were matched to pathology data. ResultsThe proportion of patients meeting screening guidelines were 32%(95%CI 26%–39%) for diabetes, 43%(95%CI 38%–47%) for cholesterol and 4.1%(95%CI 2.2%–7.3%) for cervical cancer. When patients reported having had the test, their accuracy (PPV) was low: 38%(95%CI 30%–46%) for diabetes, 47%(95%CI 42%–52%) for cholesterol, 6.5%(95%CI 3.0%–12%) for cervical cancer. However, for the minority of patients who had been screened, positive recall (sensitivity) was high: 94%(95%CI 85%–98%) for diabetes, 83%(95%CI 77%–88%) for cholesterol, 90%(95%CI 55%–98%) for cervical cancer. The accuracy of patient recall was good for those who reported not having been screened (NPV): 90%(95%CI 77%–97%) for diabetes, 70%(95%CI 61%–78%) for cholesterol, 99%(95%CI 95%–100%) for cervical cancer. ConclusionsThe results indicate that reliance on self‐report for patients’ screening history is inappropriate due to missed opportunities for health gain. However, patients who report not being tested are sufficiently accurate to ensure that ordering the test in this group will involve only a small percentage of unnecessary assays. ImplicationsGPs often rely on self‐report as a fast and inexpensive way to determine whether a patient requires screening. New strategies are needed to identify patients at risk.

Abstract C10: Insurance “instability” and colorectal cancer screening utilization

Abstract Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related death in the United States. While CRC-specific mortality has been decreasing, significant disparities by race/ethnicity and socioeconomic factors persist. Unfortunately, despite evidence that CRC screening and early detection are cost effective and reduce incidence and mortality, less than 2/3 of age-eligible adults meet screening guidelines. Research has consistently shown that patients who are insured by Medicaid or are uninsured are even less likely to be screened than those who are privately insured. However, while much research treats insurance status as a stable factor, many low income people cycle on and off insurance. Thus, studies may oversimplify the association between insurance status and preventive care. Our goal in this analysis is to describe how patient demographic characteristics, specifically the varied experience of insurance, are associated with CRC screening rates in “real world” settings. Methods: We analyzed baseline data from patients in four urban federally qualified health centers participating in a randomized controlled trial to promote CRC screening. These in-person interviewer-administered surveys included items on socioeconomic factors, healthcare, and screening utilization. We examined bivariate associations to determine differences in past screening utilization. Patients were defined as screening “up-to-date” if they had received a fecal occult blood test in the past year and/or a flexible sigmoidoscopy or colonoscopy within the past 5 years. Based on current screening guidelines, we excluded people under the age of 50 from our analysis. Of the 329 patients surveyed across the 4 centers, 289 (87.8%) were age ≥50 and were included in this analysis. Results: Of these 289 patients, 115 (39.8%) met the criteria for being screening up-to-date. The sample had slightly more females than males (54.3% vs. 45.7%) and was primarily African-American (84.4%). Initial results show statistically significant demographic differences by screening status (p&amp;lt;0.05). The up-to-date patients were older (mean age, 57 vs. 55), and more likely to be female (64.1% vs. 46.9%), have a personal healthcare provider (95.7% vs. 67.2%) and feel “very” or “extremely” comfortable discussing CRC screenings with a primary care doctor (92.3% vs. 75.6%) than patients who were not up-to-date. Additionally, up-to-date patients were less likely to have been homeless in the past 12 months (12.8% vs 31.1%) and less likely to have put off healthcare needs in the past 12 months due to cost concerns (24.8% vs 41.2%) or lack of transportation (17.9% vs. 28.8%). We saw no significant differences in screening status by education level or race. Up-to-date patients were significantly more likely to be currently insured (86.3% vs. 61.9%) than not up-to-date patients. Among those insured (n=210; 71.4%), up-to-date patients were less likely to have had a period without insurance in the past 12 months (19.8% vs. 33.9%) and had different distributions of insurance type than not up-to-date patients. Discussion: Less than 40% of age-eligible patients were screening up-to-date in our study. Examining differences between up-to-date and not up-to-date patient populations can provide insight into what factors might be important in promoting CRC screening in medically underserved populations. Our preliminary findings indicate that insurance stability might play a positive role in CRC screening adherence. Statistical modeling might better characterize the role of insurance in screening. Researchers might consider the nuances of measuring insurance and the stability of insurance when studying the association between insurance status and healthcare utilization. In addition to guiding future research, these findings could drive future politico-structural improvements to health care policy. Citation Format: Kunal M. Mathur, Meera Muthukrishnan, Graham A. Colditz, Aimee S. James. Insurance “instability” and colorectal cancer screening utilization. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C10.

A pilot test of a church-based intervention to promote multiple cancer-screening behaviors among Latinas.

We assessed the feasibility, acceptability, and initial impact of a church-based educational program to promote breast, cervical, and colorectal cancer screening among Latinas ages 18 years and over. We used a one-group pre-/post-evaluation within a low-income, Latino Baptist church in Boston, MA. Participants completed interviewer-administered assessments at baseline and at the end of the 6-month intervention. Under the guidance of a patient navigator (PN), women from the church (peer health advisors, or PHAs) were trained to deliver evidence-based screening interventions, including one-to-one outreach, small group education, client reminders, and reduction of structural barriers to screening. The PN and PHAs also implemented a health fair, and the pastor integrated health information into regular sermons. At pre-intervention, nearly half of the sample did not meet screening guidelines. The majority (97%, n = 35) of those who completed the post-intervention assessment participated in intervention activities. Two thirds (67%) reported talking with the PN or PHAs about health issues. Participation in small group education sessions was highest (72%), with health fairs (61%) and goal setting (50%) also being popular activities. Fourteen percent also reported receiving help from the PN in finding a primary care provider. This study supports the feasibility and acceptability of churches as a setting to promote cancer screening among Latinas.

Predictors of Colorectal Cancer Surveillance among Radiation-treated Survivors of Childhood Cancer

Abstract Purpose: To identify predictors of adherence to colorectal cancer (CRC) surveillance guidelines among survivors of childhood cancer who received ≥30 Gy radiotherapy to the abdomen, pelvis, or spine, and were 36 years or older at the time of last contact. Methods: We sought to identify predictors of self-reported CRC surveillance participation among 5-year survivors who completed the Childhood Cancer Survivor Study (CCSS) 2007 Follow-Up Questionnaire and met the criteria above. Univariate and multivariable generalized linear models with a log link and Poisson distribution were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to CRC surveillance guidelines (i.e., home stool blood testing and/or colonoscopy/sigmoidoscopy). Results: The mean age of 711 childhood cancer survivors eligible for the study was 44 years (SD = 5.2 years). Among them, 231 (32.5%) reported ever performing home stool blood testing and 276 (38.8%) reported ever having colonoscopy or sigmoidoscopy. Of the 711 participants, 60 (8.4%) reported home stool blood testing in the past year (meeting screening guidelines for the general adult population) and 207 (29.1%) reported having a colonoscopy or sigmoidoscopy in the past 5 years (meeting surveillance recommendations for survivors of childhood cancer treated with radiation). In the multivariable analyses, factors associated with CRC surveillance were age 50 years or older (RR = 2.4, 95% CI = 1.9–2.9); having routine cancer follow-up visit within one year prior to questionnaire completion (RR = 1.7, 95% CI = 1.2–2.5); having a physical impairment requiring the assistance of others for routine activities of daily living (RR = 1.7, 95% CI = 1.2–2.2); and having discussed future cancer risk with a physician at their most recent follow-up visit (RR = 1.3, 95% CI = 1.1–1.6). Conclusions: More than 70% of survivors at risk for CRC were not screened as recommended. Indeed, unless a physician discussed their future cancer risk, most survivors were not screened until they reached age 50, the time at which CRC screening is recommended for individuals at average CRC risk. These findings underscore the need for education of survivors and their physicians regarding the heightened CRC risk following radiation.