Participation In Cancer Screening Programs Research Articles

The Effects of Health Disparities on Perceptions About Lung Cancer Screening: Results From a National Survey

SESSION TITLE: Cultural Diversity and Palliative Care SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Health disparities are known to negatively impact participation in cancer screening programs. While this has previously been shown for colon and breast cancer screening, their impact upon lung cancer screening (LCS) has not been defined. We conducted a Web-based national survey to evaluate whether health disparities affect perceptions about LCS and therefore may have negative effects on particiption. We hypothesized that individuals of low socioeconomic status (SES) and minority racial and ethnic groups would differ in their responses to questions about susceptibility to lung cancer, benefits of LCS, and barriers to LCS compared to White or higher SES individuals. METHODS: A 96 question web-based survey was distributed nationally via SurveyMonkey and Cint databases to approximately 8700 current or former smokers aged 55-80 years. The survey included a modified version of the Champion Barrier Scale (CBS) (1), consisting of questions about susceptibility to lung cancer, benefits of LCS, and barriers to LCS. All individual items on the CBS were scored on a 4 point scale, ranging from 1 (very likely) to 4 (very unlikely). We created average scores for susceptibility, barriers, and benefits based on answers to category-specific items. Low SES was defined as either a household income less than $35,000 per year or educational attainment of high school diploma or less. We used analyses of variance to examine whether average scores for susceptibility, barriers and benefits differed by SES, educational level, household income level, or race (White, African-American, other). All analyses were performed with SAS 9.4. We used an alpha level of 0.05. RESULTS: A total of 756 responses were received (response rate 8.7%). 79.6% of respondents identified as White, 14.3% as African-American and 6.4% identified as Hispanic. 51.2% of respondents were female. 22.8% reported having the equivalent of a high school diploma or less. 41.7% reported annual household income less than $35,000. Half (51%) of our sample was low SES using the definition above. Mean scores for susceptibility and barriers did not differ significantly by race, income or educational status (p>0.05). Low SES individuals were more likely (p=0.02) to perceive benefits of screening, but the clinical importance of this difference in mean benefit scores between the two groups (1.9 for low SES vs 1.8 for others) is likely small. CONCLUSIONS: This national survey suggests that health disparities do not significantly impact perceptions of susceptibility to lung cancer, benefits of LCS or barriers to LCS. However, we must be cautious with generalization of these findings given the low survey response rate. CLINICAL IMPLICATIONS: Although our survey did not detect particular ethnic, racial or low socioeconomic status barriers to utilization of lung cancer screening, further studies may be helpful to ensure that appropriate outreach mechanisms can be instituted to facilitate screening across diverse populations. DISCLOSURE: The following authors have nothing to disclose: Sarah Ellen Stephens, Beverly Levine, Christina Bellinger No Product/Research Disclosure Information

Cancer screening participation in schizophrenic outpatients and the influence of their functional disability on the screening rate: A cross-sectional study in Japan.

The influence of schizophrenic patients' functional disability on cancer screening participation worldwide is unclear. There are few findings on the disparities in schizophrenic patients' participation in cancer screening programs in Asia. The aim of this study was to investigate the screening rate and the associations between screening and symptom severity/functional disability in patients with schizophrenia. This cross-sectional study was conducted in a psychiatric hospital outpatient clinic in Japan. We recruited schizophrenic patients meeting the national program criteria for cancer screening for colorectal, gastric, lung, breast, and cervical cancer (n = 224, 223, 224, 110, and 175, respectively). Receipt of cancer screenings was assessed using a self-report questionnaire. Scores on the modified Global Assessment of Functioning (mGAF) were evaluated by participants' primary psychiatrists. Rates of cancer screenings were as follows: 24.1% for colorectal, 21.5% for gastric, 30.8% for lung, 25.5% for breast, and 19.4% for cervical cancer. A multivariable logistic analysis showed that a 1-point increase in severity/disability (100 minus mGAF score) was associated with significantly lower odds ratios (OR) for receipt of cancer screenings, except for breast cancer (OR, 0.95, 95% confidence interval [CI], 0.93-0.98 for colorectal; OR, 0.96, 95%CI, 0.93-0.98 for gastric; OR, 0.95, 95%CI, 0.93-0.97 for lung; OR, 0.97, 95%CI, 0.94-1.00 for breast; and OR, 0.95, 95%CI, 0.92-0.98 for cervical cancer). The findings demonstrated low rates of cancer screenings in schizophrenic patients in Japan. Our study suggests the need to encourage attendance at cancer screenings, especially in schizophrenic patients with severe symptoms/functional disability.

Evidence of elevated colorectal cancer and adenoma rates for regional National Bowel Cancer Screening Program participants.

Evidence of elevated colorectal cancer and adenoma rates for regional National Bowel Cancer Screening Program participants.

Does socio-economic status in Greece affect participation in cancer screening programmes during the period of financial crisis?

ᅟ Primary health care reflects a country’s health level in relation to the current social and economic conditions according to the Declaration of Alma Ata (1978). Secondary prevention activities (Pap smear test, mammogram) promote public health through the early diagnosis of a disease. Since 2011 in Greece, due to the financial crisis, a significant reduction of national public health funding has occurred, along with substantial annual family income suppression and an increasing use of public health services.

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial

Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population. We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis. FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups. Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

제주도 대장암 발생률 추세에 대한 연구

Abstract The age-adjusted incidence rate (AAR) of colorectal cancer in Korea peaked in 2011 and then began todecline. However, the AAR of colorectal cancer in Jeju increased continually from 1999 to 2013. Compared with the16 major cities in Korea, the inhabitants of Jeju-do have a low cancer screening program participation rate, high alcohol consumption rate and high BMI. The present study aimed to provide a statistical basis for the lowering ofthe incidence of colorectal cancer in Jeju-do. The Jeju regional cancer institute data from 1999 to 2013 was usedto analyze the between Jeju-do and Korea using the Joinpoint Regression program (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute) Version 4.2.0 - April 2015. The AARof colorectal cancer in Jeju-do has being increasing because of the increase in the rates of male colon cancer (averageannual percent change 8.422%, p-value< 0.000), female colon cancer (AAPC 6.136%, p-value< 0.000), male rectal cancer (AAPC 4.221%, p-value 0.003) and colon cancer in people aged over 50 years (AAPC 7.986% p-value< 0.000). The results of this study suggest that the treatment of precancerous lesions of the male rectum and lowering of the incidence of colon cancer in people aged over 50 years are necessary to reduce the colorectal cancer incidencerate in Jeju-do.

Do no harm: no psychological harm from colorectal cancer screening.

Background:Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality. The present study aimed to investigate possible psychological harm of participation in a colorectal cancer (CRC) screening pilot in Norway.Methods:In a prospective, randomised trial participants (aged 50–74 years) were invited to either flexible sigmoidoscopy (FS) screening, faecal immunochemical test (FIT), or no screening (the control group; 1 : 1: 1). Three thousand two hundred and thirteen screening participants (42% of screened individuals) completed the Hospital Anxiety and Depression Scale questionnaire as well as the SF-12—a health-related quality of life (HRQOL) questionnaire when invited to screening and when receiving the screening result. A control group was invited to complete the questionnaires only. Two thousand six hundred and eighteen control participants (35% of invited individuals) completed the questionnaire.Results:A positive screening result did not increase participants' level of anxiety or depression, or decrease participants' level of HRQOL. Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions. However, no change was considered to be of clinical relevance.Conclusion:The current study showed no clinically relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening, in a Norwegian population.

Small-area spatio-temporal analyses of participation rates in the mammography screening program in the city of Dortmund (NW Germany).

BackgroundThe population-based mammography screening program (MSP) was implemented by the end of 2005 in Germany, and all women between 50 and 69 years are actively invited to a free biennial screening examination. However, despite the expected benefits, the overall participation rates range only between 50 and 55 %. There is also increasing evidence that belonging to a vulnerable population, such as ethnic minorities or low income groups, is associated with a decreased likelihood of participating in screening programs. This study aimed to analyze in more detail the intra-urban variation of MSP uptake at the neighborhood level (i.e. statistical districts) for the city of Dortmund in northwest Germany and to identify demographic and socioeconomic risk factors that contribute to non-response to screening invitations.MethodsThe numbers of participants by statistical district were aggregated over the three periods 2007/2008, 2009/2010, and 2011/2012. Participation rates were calculated as numbers of participants per female resident population averaged over each 2-year period. Bayesian hierarchical spatial models extended with a temporal and spatio-temporal interaction effect were used to analyze the participation rates applying integrated nested Laplace approximations (INLA). The model included explanatory covariates taken from the atlas of social structure of Dortmund.ResultsGenerally, participation rates rose for all districts over the time periods. However, participation was persistently lowest in the inner city of Dortmund. Multivariable regression analysis showed that migrant status and long-term unemployment were associated with significant increases of non-attendance in the MSP.ConclusionLow income groups and immigrant populations are clustered in the inner city of Dortmund and the observed spatial pattern of persistently low participation in the city center is likely linked to the underlying socioeconomic gradient. This corresponds with the findings of the ecological regression analysis manifesting socioeconomically deprived neighborhoods as risk factors for low attendance in the MSP. Spatio-temporal surveillance of participation in cancer screening programs may be used to identify spatial inequalities in screening uptake and plan spatially focused interventions.

The Effect of National Cancer Screening on Disparity Reduction in Cancer Stage at Diagnosis by Income Level.

BackgroundEarly detection of cancer is an effective and efficient cancer management strategy. In South Korea, the National Health Insurance administers the National Cancer Screening Program to its beneficiaries. We examined the impact of the National Cancer Screening Program on socioeconomic disparities in cancer stage at diagnosis.MethodsCancer patients registered in the Korean Central Cancer Registry from January 1, 2010 to December 31, 2010 with a diagnosis of gastric cancer (n = 22,470), colon cancer (n = 16,323), breast cancer (n = 10,076), or uterine cervical cancer (n = 2,447) were included. Income level was divided into three groups according to their monthly contribution of National Health Insurance. We employed absolute (age-standardized prevalence rate, slope index of inequality) and relative (relative index of inequality) measures to separately examine social disparities among participants and non-participants of the National Cancer Screening Program in terms of the early-stage rate.ResultsAge-standardized prevalence rates of early-stage by income group were always higher in participants than in non-participants. Furthermore, the age-standardized prevalence rate of early-stage in the low income group of the participants was also higher than that of the high income group of the non-participants. The sizes of disparities (both slope index of inequality and relative index of inequality) are smaller in participants compared to non-participants.ConclusionNational Cancer Screening Program participation reduced income disparity in cancer stage at diagnosis. Population-based cancer screening programs can be used as an effective measure to reduce income disparity in cancer care.

Maximising the efficiency of clinical screening programmes: balancing predictive genetic testing with a right not to know.

We explored the dilemma between patients' right not to know their genetic status and the efficient use of health-care resources in the form of clinical cancer screening programmes. Currently, in the Netherlands, 50% risk carriers of heritable cancer syndromes who choose not to know their genetic status have access to the same screening programmes as proven mutation carriers. This implies an inefficient use of health-care resources, because half of this group will not carry the familial mutation. At the moment, only a small number of patients are involved; however, the expanding possibilities for genetic risk profiling means this issue must be addressed because of potentially adverse societal and financial impact. The trade-off between patients' right not to know their genetic status and efficient use of health-care resources was discussed in six focus groups with health-care professionals and patients from three Dutch university hospitals. Professionals prefer patients to undergo a predictive DNA test as a prerequisite for entering cancer screening programmes. Professionals prioritise treating sick patients or proven mutation carriers over screening untested individuals. Participation in cancer screening programmes without prior DNA testing is, however, supported by most professionals, as testing is usually delayed and relatively few patients are involved at present. Reducing the number of 50% risk carriers undergoing screening is expected to be achieved by: offering more psychosocial support, explaining the iatrogenic risks of cancer screening, increasing out-of-pocket costs, and offering a less stringent screening programme for 50% risk carriers.

Cancer screening in women with intellectual disabilities

In the Republic of Ireland, more than 8000 women with intellectual disabilities (IDs), aged 20 years and over, are registered for service provision. Their health needs challenge preventative health services including breast and cervical cancer screening programmes. This review explores the literature about cancer screening participation rates and issues related to screening for Irish women with IDs. Low cancer screening participation rates are evident in Irish women with IDs; and the women shed light on the barriers they perceive related to the screening experience. These experiences are reflected in the international literature for women with IDs. Further research involving the assessment of the breast and cervical cancer awareness in Irish women with IDs and their participation in cancer screening programmes is recommended. Strategies are required to increase their participation in screening programmes that may lead to the earlier diagnosis with better outcomes.

Quality of Life and Healthcare Use in a Randomized Controlled Lung Cancer Screening Study

Understanding the quality of life of lung cancer screening program participants, and the impact of program participation on quality of life and healthcare use, will help in the assessment of the value of screening. Determine the quality of life of participants in a lung cancer screening study and assess the effect of an abnormal screening finding on quality of life and healthcare use. Quality-of-life measures and data on the use of healthcare services were collected prospectively during a randomized controlled lung cancer screening trial using chest radiography with computer-aided detection. Comparisons of baseline measures were made with U.S. population norms for the EuroQol 5-Dimension index. The impact of receiving a message of the presence of a lung nodule was assessed for all measures. A total of 1,424 subjects participated. Twenty-five actionable nodules were reported. Baseline EuroQol 5-Dimension index scores were higher than U.S. population norms (P < 0.0001). The EuroQol 5-Dimension index score and St. George's Respiratory Questionnaire symptom score showed a significant change toward poorer quality of life after notification of the presence of a lung nodule (0.940 vs. 0.877, P = 0.022, and 25.7 vs. 34.0, P = 0.005, respectively). Chest imaging within 6 months of the screening examination occurred more frequently in those notified of a lung nodule (25.5 vs. 9.3%, P = 0.002). Those who choose to enter a lung cancer screening program have a high baseline quality of life. The report of an abnormal screening finding can lower the quality of life and lead to increased chest imaging. Clinical trial registered with www.clinicaltrials.gov (NCT01663155).

Clinical management of obese patients with cancer

A large body of epidemiological evidence links obesity to increased cancer incidence, with some studies also indicating poorer survival in obese patients with cancer. Obese patients face several specific challenges related to diagnosis and treatment of cancer. Reduced participation in cancer screening programmes, lower tumour-marker expression and issues with medical imaging among obese individuals complicate cancer diagnosis. Chemotherapy and hormonal therapy in obese patients with cancer is affected by altered pharmacokinetics and hormone levels. In addition, the precision of radiotherapy might be adversely affected in this population by greater skin motility and increased motion of internal organs. Obese patients also face higher risk of minor complications after surgery. There is a need for additional research addressing issues specifically associated with the clinical management of obese patients with cancer, including comorbidity, polypharmacy, and problems related to sarcopenia and health-related quality of life. This Review summarizes the available literature addressing the clinical management of obese patients with cancer and discusses opportunities to improve the cancer care of these patients.

AB0821-HPR Participation in cancer screening programmes among females with inflammatory arthritis

BackgroundPatients with Rheumatoid Arthritis (RA) or other autoimmune diseases are at higher risk of developing certain malignancies compared with the general population(1). The National Cancer Screening Service currently encompasses Breast...

Abstract A27: Addressing linguistic needs for non-native English speakers: Assessing video technology as a means for increasing cancer screening.

Abstract Non-native English speakers face exceptional challenges when navigating the U.S. health care system. Despite research highlighting limited knowledge of cancer, low rates of participation in cancer screening programs, and cancer disparities for underserved populations, there are few culturally adapted prevention programs to enhance cancer screening among non-native English speakers. One of the major concerns for some recent immigrant and refugee communities includes limited literacy in English and/or their native language. Therefore, there is a need for interventions that employ novel formats to address the linguistic and literacy barriers to health education. The use of video technology provides a cost-effective method for reaching widespread audiences; however, there is limited information on the effectiveness of such methodologies as an intervention tool. The current research includes a systematic review of the literature to identify existing health education and cancer screening promoting programs for non-native English speakers using a video format. Literature searches were carried out via academic databases and public platforms in order to identify academic, corporate, and non-profit video materials developed targeting non-English speakers. Videos were reviewed to assess: (1) the target communities and languages available; (2) whether the videos contain up-to-date cancer screening recommendations; (3) availability and dissemination of materials to the public; (4) the presence, quality, and results from evaluation of the materials. The review of existing videos identified significant gaps in all aspects of evaluation of the videos, including information on the breadth of dissemination, cost-effectiveness, viewer satisfaction and understanding of the videos, and the ability of the videos to increase participation in cancer screening programs. The majority of video programs was developed by public sector organizations and either no evaluation information was readily accessible or, if available, the review found that limited to no evaluation had been conducted. There is significant need to develop theory-based video health education programs that track the dissemination and effectiveness of the videos to increase cancer screening participation for non-native English speakers. While video technology may provide a useful methodology for reducing cancer disparities, further research is needed. Citation Format: Kate E. Murray, Amy Pan, Alice Mills, Maria Lourdes F. Reyes, Sahra Abdi, Hope Velarde, Pat Clark, Rachel Bennett, Veronica Villarreal, Alison Olsen. Addressing linguistic needs for non-native English speakers: Assessing video technology as a means for increasing cancer screening. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A27.

Socio-economic disparities in behavioural risk factors for cancer and use of cancer screening services in Korean adults aged 30 years and older: The Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III)

To estimate the current status of cancer-related health disparities in cancer risk factors and the use of cancer screening services by Korean adults. Cross-sectional survey study. The disparities of behavioural cancer risk factors and use of cancer screening services according to equivalent monthly household income were evaluated, using multivariate logistic regression analysis, among 6466 subjects aged ≥30 years and who completed the health promotion knowledge, attitude and practice survey, which is part of the Third Korean National Health and Nutrition Examination Survey. In men, smoking (P for trend = 0.05) and physical inactivity (P for trend = 0.05) were more common in the lower-income group, while high-risk drinking (P for trend <0.01) was more common in the higher-income group. In women, physical inactivity (P for trend <0.01) was more common in the lower-income group, while smoking and high-risk drinking showed no income disparities. Income disparities were also found in the degree of participation in cancer screening programmes. Men in the highest income quintile underwent more screening for both colorectal and gastric cancer than men in the lowest income quintile and men in the second to fourth income quintiles (P for trend <0.01 for both). Women in the highest income quintile underwent more screening for cervical (P for trend <0.01) and gastric (P for trend = 0.04) cancer, while income disparities were not seen for participation in colorectal or breast cancer screening. In order to decrease behavioural risk factors and promote participation in cancer screening programmes, more targeted efforts are needed for cancer prevention among lower-income Koreans.

Cancer screening among migrants in an Australian cohort; cross-sectional analyses from the 45 and Up Study

BackgroundLimited evidence suggests that people from non-English speaking backgrounds in Australia have lower than average rates of participation in cancer screening programs. The objective of this study was to examine the distribution of bowel, breast and prostate cancer test use by place of birth and years since migration in a large population-based cohort study in Australia.MethodsIn 2006, screening status, country of birth and other demographic and health related factors were ascertained by self-completed questionnaire among 31,401 (16,126 women and 15,275 men) participants aged 50 or over from the 45 and Up Study in New South Wales.Results35% of women and 39% of men reported having a bowel cancer test and 57% of men reported having a prostate specific antigen (PSA) test, in the previous 5 years. 72% of women reported having screening mammography in the previous 2 years. Compared to Australian-born women, women from East Asia, Southeast Asia, Continental Western Europe, and North Africa/Middle East had significantly lower rates of bowel testing, with odds ratios (OR; 95%CI) ranging from 0.5 (0.4–0.7) to 0.7 (0.6–0.9); migrants from East Asia (0.5, 0.3–0.7) and North Africa/Middle East (0.5, 0.3–0.9) had significantly lower rates of mammography. Compared to Australian-born men, bowel cancer testing was significantly lower among men from all regions of Asia (OR, 95%CI ranging from 0.4, 0.3–0.6 to 0.6, 0.5–0.9) and Continental Europe (OR, 95%CI ranging from 0.4, 0.3–0.7 to 0.7, 0.6–0.9). Only men from East Asia had significantly lower PSA testing rates than Australian-born men (0.4, 0.3–0.6). As the number of years lived in Australia increased, cancer test use among migrants approached Australian-born rates.ConclusionCertain migrant groups within the population may require targeted intervention to improve their uptake of cancer screening, particularly screening for bowel cancer.

Age, health beliefs, and attendance to a mammography screening program in the community of Valencia

Age has a significant bearing on health beliefs related to participating in breast cancer screening programs. This study is aimed at analyzing the breast cancer-related beliefs and attitudes influencing screening program participation among different age groups. In a transversal study, a comparison is drawn between the health-related beliefs of a group of women participating in a screening program and a group of non-participating women, taking into account three age ranges (under age 50 (N = 279), 50-60 age range (N = 463), and over age 60 (N = 271). Some variables significantly differ between the participating and non-participating women solely in certain subgroups: perceived severity (50-60 age group: F = 5.14; p < 0.01); perceived benefits (under age 50: F = 8, 18; p < 0.01; over age 60: F = 4.54; p < .05); mammogram-related attitude (under age 50: F = 56.67; p? .001; over age 60: F = 18.42; p < 0.001); professional health checkups (under age 50: F = 11.30: p < 0.01) and luck or chance (under age 50: F = 3.78; p < 0.05; 50-60 age group: F = 4.29; p < 0.001). More specific beliefs, assessed by items from these scales, are also statistically significant (p < 0.05), although only for certain age groups. Women's breast cancer prevention program participation related beliefs and/or attitudes differ in terms of their age.

Secondary cancer prevention in the elderly

Cancer incidence rises as the population ages. Fifty percent of all cancer diagnoses and 60% of all cancer deaths in the United States occur in people older than 65 years of age. Because the elderly are underrepresented in cancer screening activities, the identification of factors that encourage or discourage them to engage in secondary cancer prevention activities is a health care priority. The purpose of this study was to investigate the relationship between health perception (measured by Ware's HPQ) and participation in cancer screening programs (measured by PCSQ) in 323 elderly New Yorkers from a variety of backgrounds. A statistically significant (p < 0.001) moderate positive correlation between both variables (r = 0.51) was found by using the Pearson's Product Moment Correlation. The researcher's hypothesis, that there is a relationship between both variables, was supported. The results indicate that in addition to health perception, demographic factors (measured by DDQ), including education, economic status, ethnic group, and gender, are predictors of participation in cancer screening.