Pilot Screening Program Research Articles

Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU

In the setting of the coronavirus disease 2019 (COVID-19) pandemic, new strategies are needed to address the unique and significant palliative care (PC) needs of patients with COVID-19 and their families, particularly when health systems are stressed by patient surges. Many PC teams rely on referral-based consultation methods that can result in needs going unidentified and/or unmet. Here, we describe a novel system to proactively identify and meet the PC needs of all patients with COVID-19 being cared for in our hospital's intensive care units. Patients were screened through a combination of chart review and brief provider interview, and PC consultations were provided via telemedicine for those with unmet needs identified. In the first six weeks of operation, our pilot program of proactive screening and outreach resulted in PC consultation for 12 of the 29 (41%) adult patients admitted to the intensive care unit with COVID-19 at our institution. Consultations were most commonly for patient and family support as well as for goals of care and advance care planning, consistent with identified PC needs within this unique patient population.

Pilot screening program for lower extremities atherosclerotic disease in a population of central Greece.

Screening program in lower extremity atherosclerotic disease (LEAD) has not been widely implemented from health systems. The aim of this study was to assess the incidence of LEAD in Greece though a pilot LEAD screening program. Males >60 years old without known diagnosis of LEAD or chronic renal disease were invited through public primary health care institutions to participate in a pilot screening program in Central Greece. Demographics, atherosclerotic risk factors and other comorbidities were recorded. LEAD was defined as ankle-brachial pressure index (ABPI) of <0.9 or >1.4. Among a total of 1152 individuals (invitation acceptance 70%; 1152/1638) LEAD was detected in 13% (148); including 7% with ABPI<0.9 and 6% with ABPI>1.4. Comparing the groups with ABPI<0.9 vs. normal ABPI, abnormal ABPI was associated with older age (P=0.001), hypertension (HT) (P=0.037), smoking (P=0.002), duration of smoking (P=0.01), packs/year (P=0.002), coronary artery disease (P=0.02), chronic obstructive pulmonary disease (P=0.028) and cerebrovascular disease (P=0.001). After multivariate analysis, increased age (0.94, CI: 0.026-5.2; P=0.022), history of HT (2.4, CI: 0.44- 3.7; P=0.05) and longer duration of smoking (0.9, CI: 0.01-6.1; 0.013) were associated with ABPI <0.9. Abnormally higher ABPI (>1.4) was not associated with any factor. Among those without known CAD or CVD (96/148), 37.5% (36/96) were on statins and 21% (20/96) on antiplatelets. Incidence of LEAD was 13% in a male >60 years-old population of central Greece; these individuals maybe undertreated. ABPI<0.9 was diagnosed in 7% and was associated with older age, HT and duration of smoking.

The Wequedong Lodge Cancer Screening Program: implementation of an opportunistic cancer screening pilot program for residents of rural and remote Indigenous communities in Northwestern Ontario, Canada.

The rural and remote nature of many First Nations communities in Northwestern Ontario, Canada poses unique obstacles to physically accessing health care, in addition to other barriers. Indigenous peoples face similar challenges globally. First Nations communities experience significant health inequities, including cancer burden, which can be attributed to complex factors associated with colonization and Westernization. One potentially promising intervention to decrease the burden of advanced cancers is the provision of accessible, convenient and culturally sensitive cancer screening services, leading to early detection and treatment. The Wequedong Lodge Cancer Screening Program (WLCSP) was a pilot project aiming to provide cancer screening education and opportunistic cancer screening to residents from rural and remote First Nations communities while accessing health services in the urban center of Thunder Bay, Ontario, Canada. Cancer screening education and opportunistic breast, cervical and colorectal cancer screening appointments were offered to individuals and their travel escorts already staying at Wequedong Lodge. Program uptake was determined primarily by education participation, and secondarily by client participation in screening. In total, the WLCSP booked 1033 appointments, with 841 being attended. Over the program's 3 years there was an increase in clients each year. Specifically, 22% (60/275) of age-eligible women completed a mammogram. Pap tests were provided to 8% (45/554) of age-eligible females. Finally, 32% (106/333) of all age-eligible service participants were given a fecal occult blood test kit. An evaluation survey (n=396) demonstrated overall client satisfaction with the program. The WLCSP aimed to provide education about, access to and uptake of cancer screening services for First Nations people from rural and remote communities in Northwestern Ontario by targeting inequalities in accessing cancer screening opportunities. Therefore, program uptake may provide helpful numerical comparisons for similar future programs globally. Other entities working to improve cancer screening rates in remote and/or rural populations and/or amongst Indigenous peoples may find consideration of the WLCSP processes, successes and challenges helpful to their efforts.

ScreenPlus: A comprehensive, dynamic, multi-disorder newborn screening pilot program

ScreenPlus: A comprehensive, dynamic, multi-disorder newborn screening pilot program

Data analysis of a pilot screening program for the early detection of esophageal and gastric cancers: retrospective study

BACKGROUND: According to the WHO, in 2018 stomach cancer was the fifth and esophageal cancer seventh most common cancer in the world. In 2011 the National Screening Program for the Early Detection of Breast, Cervical, and Colorectal Cancer was introduced in Kazakhstan. In 2013 a pilot screening program for the early detection of esophageal and stomach cancers was introduced in Kazakhstan in some regions where there is a low detectability.&#x0D; AIM: Determination of the main causes of low detection of esophageal and stomach cancers in the framework of a pilot screening program in Pavlodar region (Kazakhstan).&#x0D; METHODS: According to the Ministry of Healthcare of the Republic of Kazakhstan, the target group for screening to detect esophageal and stomach cancers was men and women at the aged of 50, 52, 54, 56, 58 and 60 who were not registered as a cancer patient. A retrospective analysis was carried out according to the newly diagnosed cases of esophageal and stomach cancers in Pavlodar region for 20132017. All cases of esophageal and stomach cancers were analyzed to determine the proportion of new cases detected as part of a pilot screening program.&#x0D; RESULTS: 1114 new cases of esophageal and stomach cancers are registered from 2013 to 2017 in Pavlodar region. According to the data in Pavlodar region the average age of newly diagnosed patients with esophageal and stomach cancers was 66 years, M = 65.92 (95 % CI: 65.2466.59) SD = 11.495. During pilot screening program, 135 042 participants were examined; various pathological processes of the esophageal and stomach cancers were detected among 1678 patients, including 97 cancer cases. The detectability of esophageal and stomach cancers from the total number of participants was 0.07 %. Out of 1114 all registered new cases of esophageal and stomach cancers, only 97 new diagnosed cases detected as part of a pilot screening program, reaching 8.7 %, which is considered low.&#x0D; CONCLUSIONS: The main reasons for low detection are administrative barriers. The main barrier of the pilot screening program was the selection of the target group at the age of 50, 52, 54, 56, 58, 60 years old only. Therefore, 15.5 % of newly diagnosed cases of esophageal and stomach cancers were missed due to existing intervals. The second barrier was the use of endoscopes which did not support the function of photo and video archiving of the conducted procedures.

A008 The Starship Cardiac Care Screening Program: A Two-year Pilot Program Screening Perceived Quality of Life and Psychosocial Outcomes for Children Diagnosed With Congenital Heart Disease (CHD)

With advances in cardiac care and increased survival, research has shifted focus to quality of life. Nearly 50% of CHD children report reduced quality of life with associated developmental, learning, emotional and behavioural challenges. Early diagnosis/intervention, including the implementation of screening programs, improve cardiac prognosis and perceived quality of life resulting in improved long- term functioning. Screening programs have proven difficult to establish in New Zealand. To address this and obtain information about the outcomes of Kiwi children with CHD, the Cardiac Care program was established at Starship Children's Hospital. The screening pilot program began in 2017 and recruited 189 CHD outpatients (2-17 years). Patient-parent pairs completed the Peds-QL Cardiac Module measuring cardiac specific health-related quality of life, developmental and psychosocial outcomes. The screening ran from February 2017-February 2019. Diagnostic categories were biventricular repair (60%), Fontan palliation (31%) and unrepaired CHD (9%). 76% of all diagnostic groups reported concerns in the areas of physical, emotional and academic development with 52% reporting peer difficulties. Lower overall Peds-QL scores were reported in the Fontan palliation group and those with increased medical intervention/hospitalisation. 7.5% of the unrepaired CHD group reported anxiety/worry. Overall, children with CHD and their parents perceived a lower quality of life with reduced psychosocial functioning and developmental difficulties. Children with more severe CHD reported worse physical and psychosocial quality of life.

Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease.

Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital. Prospective cohort study. An 800-bed, tertiary-care, academic medical center in the Bronx, New York. A sample of admitted adults without diarrhea, with oversampling of nursing facility patients. Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model. Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001). Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.

A pilot autonomous AI‐based DR screening in Poland

AbstractPurposeWe would like to share our experience and results in instigating a pilot diabetic retinopathy (DR) screening programme based on artificial intelligence (AI) in Poland. Diabetes prevalence is increasing and as a result so is DR. Only a few developed countries could so far afford to establish national screening programmes. Those were so far based on work done by ophthalmologists or specialty trained human graders.MethodsWe have set‐up our screening programme in a diabetic clinic. Patients who visited the clinic were offered DR screening based on non‐mydriatic retinal images (TRC‐NW400, Topcon). These images were analysed by IDx‐DR, a deep‐learning network based autonomous DR screening system. Based on the IDx‐DR output patients were recommended another screening after 1 year, or an ophthalmology referral with appropriate urgencyResultsAfter an initial period with a number issues related to image quality, staff training, locale etc. we have managed to get the pilot screening programme on working. The AI systems tolerance for image quality was similar to that of a human grader. Compared to an ophthalmologist’s grading the IDx‐DR system achived over 90% sensitivity and specificity for referable DR.ConclusionsThe cost of a human specialty grader based DR screening programme is prohibitively high for a developing country such as Poland in terms of both human and financial resources. The advent of AI DR screening technology brings a cheaper, easier to roll out alternative that can be successfully employed on a local level. Additionally patients receive a near‐instant result with a satisfactory accuracy. Effectiveness of such system on a larger scale remains to be seen.

Lessons Learnt from A Pilot Screening Program for Lower Extremities Atherosclerotic Disease (Lead) in A Population in Central Greece

Introduction: While screening programs for abdominal aortic aneurysms are well-established, in the peripheral arterial disease including carotid and lower extremities atherosclerotic disease (LEAD), their role is controversial without a proven benefit. The aim of the study was to present our finding from a pilot LEAD screening program in central Greece. Methods: Males > 60 years old without known diagnosis of LEAD were invited through public primary health care institutions (state insurance and municipal organizations) to participate to a screening program. Individuals were both from urban and rural areas. Age, height and weight, co-morbidities, hypertension (HT), hyperlipidemia, smoking, coronary artery disease (CAD), diabetes mellitus, chronic obstructive pulmonary disease (COPD), cerebro-vascular disease (CVD) were recorded. Also, the ankle-brachial index (ABPI) was measured from both lower limbs; abnormal values were considered those < 0.9 or >1.4. Results: Among a total of 1152 patients who joined the program (invitation acceptance was 73%) LEAD was detected in 148 (13%); including 81 (7%) with ABPI< 0.9 and 67 (5.8%) with ABPI>1.4. LEAD was associated with age (abnormal ABPI; 72.7±7 years old vs. normal ABPI; 70.9±7 years old, p=0.003), HT (abnormal ABPI; 75% vs. normal ABPI; 67%, p=0.037), COPD (abnormal ABPI; 11.5% vs. normal ABPI; 6.5%, p=0.028) and CVD (abnormal ABPI; 9.5% vs. normal ABPI; 4.5%, p=0.008). An ABPI< 0.9 was associated with age (abnormal ABPI; 74±7 years old vs. normal ABPI; 70.9±7 years old, p=0.001), HT (abnormal ABPI; 80% vs. normal ABPI; 67%, p=0.037), smoking (abnormal ABPI; 42% vs. normal ABPI; 25%, p=0.002), duration of smoking (abnormal ABPI; 38±14 years vs. normal ABPI; 32±13 years, p=0.01), packs/year (abnormal ABPI; 2±3 vs. normal ABPI; 1.5±0.9 years, p=0.002), CAD (abnormal ABPI; 35% vs. normal ABPI; 24%, p=0.02), COPD (abnormal ABPI; 14% vs. normal ABPI; 6.5%, p=0.028) and CVD (abnormal ABPI; 14% vs. normal ABPI; 4.5%, p=0.001). After multivariate analysis, increased age (0.94, CI. 0.026-5.2; p=0.022), history of HT (2.4, CI. 0.44- 3.7; p=0.05) and longer duration of smoking (0.9, CI. 0.01-6.1; 0.013) were associated with ABPI < 0.9. Only 51% of the patients with ABPI< 0.9 were under statin therapy and only 35% under antiplatelets. Abnormally higher ABPI (>1.4) was not associated with any factor. Only 42% of those patients were under statin therapy and only 15% under antiplatelet therapy. Conclusion: Incidence of LEAD was 13% in a male >60 years old population in central Greece. The incidence of an ABPI< 0.9 was 7% and it was associated with older age, HT and duration of smoking. Identification of such a population may allow better implementation of intense optimal medical treatment strategies to prevent cardiovascular mortality and morbidity. Disclosure: Nothing to disclose

Lung cancer screening by low-dose CT among asbestos-exposed workers: first results of a pilot program

Abstract Background Occupational asbestos exposure (OAE) is a risk factor for lung cancer (LC) and can cause malignant diseases decades after exposure. Lung cancer screening with low-dose computed tomography (LCS) in heavy smokers has shown LC-mortality reductions in two large trials. Recent guidelines advocate LCS in high-risk populations with OAE and additional smoking history. Methods A structured pilot program on LCS in three German regions has been implemented from 2014 to 2018. Eligibility criteria are: OAE ≥10 years starting before 1985 or diagnosis of OAE-related lung disease other than cancer, age ≥55 years and smoking history ≥30 pack years. Eligible persons are centrally invited for LCS on a voluntary basis in 12 months intervals. All persons willing to participate receive obligatory physician counselling before LCS. CT scans are performed according to a standardized protocol. The program provides technical quality assurance as well as independent double reading of all suspicious findings and of a random sample of all CT scans. Results Of 2715 and 1534 persons invited to first and second LCS, 1571 (57.9%) and 715 (46.6%) agreed to participate, respectively. Main reason for disagreement was principal refusal of LCS (15.5% in first and 22.2% in second LCS), whereas 8.5% and 6.9%, respectively, refused after counselling. Additionally, 12.9% and 5.7% did not respond at all. Effectively, 68.8% and 70.6% of those who initially agreed, received first and second LCS, respectively. Variations between regions were observed (range 61.0% to 79.8%). First preliminary outcome assessment shows detection rates of 0.019 and 0.011 in first and second LCS, respectively. Conclusions A substantial group of eligible persons with OAE participated in LCS after physician counselling. Participation remained stable over two screening rounds. First results show detection of LC in the expected range. The effectiveness of early detection of LC in OAE needs to be evaluated further. Key messages Participation over the first two screening rounds in structured lung cancer screening remained stable among eligible persons with OAE and smoking history who were counselled by physicians. Detection of lung cancer in a structured pilot screening program in three German regions seems to be within the range to be expected from previous research.

Factors associated with participation in colorectal cancer screening: a population-based study of 7200 Chinese individuals

BackgroundScreening for colorectal cancer can reduce mortality, yet, participation rate is suboptimal in various countries. We aimed to evaluate the effectiveness of a pilot programme for colorectal cancer screening on increasing the enabling factors of screening in a large Chinese population, and identified factors associated with its participation based on variables pertinent to the Health Belief Model. MethodsWe collected data from 3600 screening participants who were randomly selected using a telephone list for 2016, 2017, and 2018, from the government colorectal cancer screening programme. We also collected data from 3600 non-screening participants through a telephone survey via simple random sampling of telephone numbers in a territory-wide directory for the years 2016, 2017, and 2018. We collected sociodemographic factors, the enabling factors of screening (such as knowledge levels of colorectal cancer, perceptions of colorectal cancer screening, cues to actions), and barriers of screening. We constructed a logistic regression model to identify the association between these factors and participation in colorectal cancer screening adjusted for age, gender, educational level, and household income. The study was approved by the Joint Chinese University of Hong Kong − New Territories East Cluster Clinical Research Ethics Committee (reference number 2016.485). Verbal consent was obtained from the study participants. FindingsThe knowledge level of colorectal cancer screening tools (from 67·9% to 85·4%, p<0·001), perceived severity of having colorectal cancer (from 37·7% to 42·8%, p<0·001), perceived benefits of screening (from 54·9% to 72·1%, p<0·001), and reductions in access barriers of colorectal cancer screening (from 18·5% to 7·5%, p<0·001) significantly improved from 2016 to 2018. People with older age (adjusted odds ratio [AOR] 2·02, 95% CI 1·77–2·30, p<0·001), higher level of knowledge of screening methods (6·70, 4·40–10·20, p<0·001), greater perceived severity (2·03, 1·69–2·43, p<0·001), and coverage of insurance (1·25, 1·09–1·43, p<0·01) were more likely to participate in screening. By contrast, more affluent people (0·68, 0·57–0·80, p<0·001), female individuals (0·64, 0·56–0·72, p<0·001), higher level of perceived psychological barriers (0·54, 0·42–0·69, p<0·001), and access barriers (0·57, 0·44–0·73, p<0·001) were associated with poorer participation. InterpretationThese findings demonstrate the effectiveness of the screening programme on increasing the enabling factors and identify the target groups such as younger individuals, females, and more affluent people among whom more intensive educational initiatives are needed to enhance their participation. FundingHealth and Medical Research Fund (No. 6904168), Food and Health Bureau, Hong Kong, China.

IBS30.03 Risk Assessment to Establish Screening Programs: The Canadian Point of View

The Canadian Task Force on Preventive Health Care (CTFPHC) supports screening with low dose computed tomography (LDCT) of the chest to decrease lung cancer mortality.1 The Task Force recommends annual screening up to three consecutive years in high risk adults aged 55-74 years with at least a 30 pack-year smoking history, who currently smoke or quit less than 15 years ago. Pilot LDCT screening program or studies are being conducted in Canada to help determine how to best implement organized lung cancer screening for people at high risk at the population level. Based on emerging data that suggests both the CTFPHC and the US Preventive Services Task Force (USPSTF) age and pack-years selection criteria2 are suboptimal and that risk prediction tools such as the PLCOm2012 are more sensitive with better positive predictive power to identify ever smokers who will develop lung cancer with a lower number needed to screen to prevent one lung cancer death and are more cost-effective,3-8 pilot studies in Canada adopt the PLCOm2012 risk prediction tool to select high risk ever smokers for LDCT screening. A prospective study is being conducted in newly diagnosed lung cancer patients in the Greater Vancouver area. In 1,076 patients, 37% were never smokers reflecting the foreign-born ethnic distribution. Of the 683 ever smokers, 60% met the PLCOm2012 model 6-year risk ≥1.5% screening criteria while only 39.5% met the USPSTF screening criteria. The International Lung Screen Trial (ILST), a multi-center prospective trial in Canada (British Columbia, Alberta), Australia, Hong Kong, and the United Kingdom, offer screening to ever smokers age 55 to 80 years if they meet the USPSTF criteria or the PLCOm2012 model 6-year risk ≥1.5% criteria. Participants receive two annual screens and are followed for six years for lung cancer outcomes. Interim results in 4,863 participants with 101 lung cancers showed that PLCOm2012 identified 26.6% more lung cancers than USPSTF criteria (99% of all lung cancers versus 78% with USPSTF). However, PLCOm2012 screened 9.9% more people than USPSTF criteria. If 2% six-year lung cancer risk threshold were used for screening selection criteria as is currently used in the Cancer Care Ontario Pilot, PLCOm2012 would be 12.7% more sensitive identifying 88.1% of lung cancers while screening 11% fewer people compared to USPSTF criteria. A 1.7% six-year lung cancer risk threshold would be 24.1% more sensitive identifying 97% of all lung cancers while screening only 1% more people than USPSTF criteria. The 1.7% threshold may be a better screening selection criterion. The worldwide burden of lung cancer is significant and projected to rise during the coming years especially in East Asian countries, namely, China, Japan, South Korea and Taiwan because of the large population size, high stable incidence rates in male and significant upward trends in females many of whom are never smokers.9 With global migration and increasing number of new Canadians who are diagnosed with lung cancer are from Asian countries such as in Vancouver, better lung cancer risk assessment tools need to be developed that take into account ethnicity and other environmental exposures such as outdoor and household air pollution exposures.10 Risk prediction tools may be perceived by some to be more complex to use than age and pack-years. The web based PanCan risk prediction tool, a precursor to the validated PLCOm2012 model, was tested in both English and French in 8 centers across Canada from coast to coast.7 The tool was found to be simple to use and took approximately 5 minutes to administer over the telephone. Similar experience was found with the web based PLCOm2012 risk assessment tool for enrollment into the International Lung Screen Trial and the Cancer Care Ontario pilot screening program. Risk assessment can be readily done by a navigator or a physician for enrollment into lung cancer screening programs as part of the shared decision process. Supported by the Terry Fox Research Institute, BC Cancer Foundation, the VGH-UBC Hospital Foundation, the Alberta Cancer Foundation, and the Australian NHMRC.

Thalassemia and Hemoglobinopathies in an Ethnic Minority Group in Northern Vietnam

This study assessed thalassemia and hemoglobinopathies in a group of the Tay ethnic minority. Participants included 289 women of reproductive-age who enrolled in a pilot screening program for thalassemia conducted at six communities of Thai Nguyen Province, northern Vietnam. Standard procedures including complete blood count (CBC), hemoglobin (Hb) and DNA analyses were performed for all samples. The prevalence of thalassemia in 289 Tay women was 15.6% (gene frequency 0.078) for α0-thalassemia (α0-thal), 10.0% (gene frequency 0.050) for α+-thal, 7.3% (gene frequency 0.036) for β-thalassemia (β-thal), 2.4% (gene frequency 0.012) for Hb Constant Spring [Hb CS; α142, Term→Gln, TAA>CAA (α2), HBA2: c.427T>C] and 1.7% (gene frequency 0.009) for Hb E [β26(B8)Glu→Lys, GAG>AAG; HBB: c.79G>A]. Further analysis of β-globin gene abnormalities identified four mutations including codons 41/42 (–TCTT) (HBB: c.126_129delCTTT), codon 17 (A>T) (HBB: c.52A>T), codons 71/72 (+A) (HBB: c.216_217insA), and –28 (A>G) (HBB: c.78A>G). The results hint at the remarkably high frequencies of severe forms of thalassemia that indicate a serious public health problem requiring further exploration, and most probably, also intervention within the country.

A Pilot Programme for Tuberculosis Screening in Immigrants at Primary Care

Background: Immigrants from countries with a high prevalence of Tuberculosis (TB) may constitute a source of infection. Objective: The aim of the present study was to describe a Tuberculosis (TB) screening programme at a primary health care centre directed at immigrants from countries with a high prevalence of TB. Methods: This was a descriptive study conducted at a primary health centre in Barcelona between 2009 and 2012 for immigrants from countries with a TB incidence &gt; 100/100,000. They were invited to join the TB detection programme on registering at the primary health care centre when a reference nurse conducted a survey on socio-health data, performed a Tuberculin Skin Test (TST) and requested a chest X-ray. Interferon Gamma Release Assays (IGRA) were applied in individuals with positive TST or an abnormal X-ray. Results: Ninety-one (70.5%) of 129 individuals, aged 29.8 ± 9.8 years, who entered the programme, were men, 60 (46.5%) were from Pakistan and 3 reported previous TB. Eighty-six (66.7%) immigrants completed the study protocol. Three cases (2.3%) of TB were diagnosed and 29 (30.5%) had latent TB infection. Seven chest X-rays yielded other non-TB radiological changes. Conclusion: This TB screening programme should aid early detection of TB and LTBI among immigrants from high-TB prevalence countries on first registering at the primary health care centre.

Abstract P1-10-06: High participation of African-American women veterans in high risk breast cancer screening pilot program

Abstract SPECIFIC AIMS: To assess breast cancer risk in Women Veterans. BACKGROUND/RATIONALE: Women are the fastest growing segment of patients numbering over 2 million and breast cancer incidence has more than tripled from 1995 to 2012 within the Veterans Health Administration (VHA). Preliminary data suggest that Women Veterans may be at an increased breast cancer risk based on unique service-related exposures (e.g., burn pits, depleted uranium) and Post Traumatic Stress Disorder (PTSD). Historically, breast cancer rates among African Americans (AA) are lower than those seen in the general population (8.2-13.3%). METHODS: A pilot study was conducted at Bronx, NY and Washington, DC Veterans Affairs Medical Centers. Participants were enrolled at their regular visit to Women's Health Clinics or at breast cancer education and awareness events. 5-year and lifetime risks of developing invasive breast cancer were calculated using the Gail Breast Cancer Risk Assessment Tool (BCRAT). Demographics, PTSD status, eligibility for chemoprevention and genetic counseling using the Breast Cancer Genetics Referral Screening Tool (B-RST), were also determined. ELIGIBILITY CRITERIA: Women Veterans age ≥ 35 years with no personal history of breast cancer. RESULTS: A total of 99 Women Veterans with an average age of 54 years participated between 2015 and 2018; 60% African American (AA); 13% Hispanic; 14% non-Hispanic White and 13% as other. In total, 35% (35/99) were considered high risk with a 5-year BCRAT of &amp;gt;1.66% and of these, 51% were AA; 14% Hispanic and 17 % were other. Prior breast biopsies were performed in only 22% (22/99) of our entire Veteran population; 57% (56/99) having a family history positive for breast cancer. Comparatively, in our high risk AA alone, 33% (6/18) had prior breast biopsies with 94% (17/18) having a positive family history. High risk patients were referred for chemoprevention; 5 (19%) accepted; and 13/35 (37%) patients were referred for genetic counseling. PTSD was present in 29% overall and in 31% of the high risk subgroup. IMPLICATIONS: The VHA, which leads the nation in mammogram compliance, is an untapped potential resource for the study of breast cancer. To our knowledge, this is the only study with 60% AA Women Veterans. High participation rates among AA in this pilot study have uncovered the potential for further inquiry into this population, which is otherwise dramatically under-represented in research. Over half (51%) of AA in this pilot study had a high risk score, likely linked to a high rate of prior breast biopsies and family history. Limitations of this study include the small sample size, exclusively urban population, geography and self-selection for screening due to a higher level of concern for breast cancer. If Women Veterans are at higher risk of breast cancer, it has been assumed that this would be related to service-related exposures, PTSD and other factors. However this pilot study, which was not designed or powered to do more than raise questions, suggests the additional possibility of an innate or genetic risk, especially in AAs. Future directions include the evaluation of genetic and molecular mutations in high risk AA Women Veterans, possibly even a role for PTSD epigenetic changes and tumorigenesis. Citation Format: Park Y-HA, Keller AT, Bidassie B, Venne VL, Heron BB, Hoffman-Hōgg L, Hawley DK, Hsu T-CM, Colonna SV, Aggarwal A. High participation of African-American women veterans in high risk breast cancer screening pilot program [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-10-06.

Cervical morbidity in Alsace, France: results from a regional organized cervical cancer screening program.

In 1994, a pilot program of cervical cancer screening was introduced in the Alsace region, France. Women aged 25-65 years were proposed to have one Pap smear every 3 years. The objective was to assess cervical morbidity in Alsace before the human papillomavirus vaccinated population reaches the age of screening. Data on cervical lesions and cancers were collected by EVE for the period September 2008 to August 2011 from existing medical services and cytopathology laboratories in Alsace. Cytological and histological data were completed with data from the two cancer registries covering the region (Bas-Rhin and Haut-Rhin). Cancer incidence rates were computed for the target population (truncated to 25-64 years) and were age standardized according to the world reference population. World standardized incidence rates for the whole female population were obtained from the two cancer registries. During 2008-2011, 565 153 smears were performed in 498 913 women aged 25-64 years, representing an average of 1.13 smears/woman and 1.62 smears/screened woman. The overall screening coverage was 70.1% over the 3-year period. Histologically confirmed high-grade lesions were found in 2303 women (0.5%). Moreover, 215 cervical cancers were reported among women aged 25-64 years (crude and standardized truncated incidence rate of 10.6 and 10.0/100 000 women-years, respectively). The overall screening coverage of 70% at 3 years is higher than the national rate (57%), and the overall cancer incidence of 5.5/100 000 is below the national French level. The EVE database will be useful to assess trends in cervical morbidity over time and to further assess the effect of screening as well as of human papillomavirus vaccination.

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China.

China has a very high tuberculosis (TB) burden. The interferon-gamma release assay (IGRA) is more specific for the diagnosis of latent tuberculosis infection (LTBI) than the tuberculin skin test, especially among populations with a high degree of coverage by the BCG vaccine. To evaluate the first screening of healthcare workers (HCW) for LTBI using the IGRA at a general hospital in Beijing. A pilot screening program for LTBI was triggered by accidental contact between HCW and two patients with active TB in the emergency department (ED). Given the necessity of estimating the overall LTBI prevalence in the institution, a sample of 518 HCW was enrolled in our cross-sectional study. The second IGRA was repeated with 43 of the 121 HCW in the ED after exposure to index TB cases. Data on putative risk factors were collected with a self-administered questionnaire. The prevalence of LTBI in the targeted population was 21.8%. Differences in the prevalence of LTBI were significantly related to age, employment duration, and history of occupational exposure. A lack of childhood BCG vaccination was independently associated with the prevalence of LTBI (adjusted OR: 1.686, 95% CI: 1.045-2.723, P=.0325). No new LTBI was diagnosed 12 weeks postexposure. No HCW adopted the preventive treatment for LTBI. Considering the high morbidity of LTBI among HCW even in general hospitals, it is essential to formulate government policies and institutional operation protocols for the systematic screening, registration, and administration of prophylaxes for the control of LTBI.

Spectacle Compliance and Its Determinants in a School Vision Screening Pilot in Botswana

ABSTRACTPurpose: The effectiveness of school eye health programmes relies on many factors, including compliance with spectacle wear. The objectives of this study were to determine spectacle compliance in a school vision screening pilot programme in Botswana, and investigate factors predictive of compliance.Methods: The study was an observational, cross-sectional follow-up of a pilot school screening programme. Unannounced compliance checks were completed after 3–4 months in a convenience sample of 19 schools. Sex, age, school level, visual acuity, and refractive error were analysed using logistic regression to investigate factors predictive of compliance.Findings: Compliance data were recorded for 193/286 (67.5%) children; 62.2% were female and the median age was 15 years (interquartile range 12–17 years). 60.1% of the sample were compliant with spectacle wear. Girls were more likely to be compliant than boys (adjusted odds ratio (aOR) = 2.32, 95% confidence interval (CI) 1.03–5.27). Children at primary and junior secondary school were more likely to be complaint than senior secondary school children (aOR = 16.96, 95% CI 5.60–51.39; and aOR = 3.39, 95% CI 1.39–8.22, respectively). Children with binocular uncorrected visual acuity (UCVA) of 6/7.5 to 6/12 were 2.76 (95% CI1.05–7.23) times more likely to be compliant than children with binocular UCVA of 6/6.Conclusion: Compliance was higher in Botswana than previous African studies; however, improvement in this area would increase the effectiveness of the programme. Further investigation into barriers to spectacle wear affecting boys and older children is warranted. A prescribing protocol to avoid low prescriptions – especially where binocular UCVA is 6/6 – is desirable.

Population-based organized cervical cancer screening pilot program in France.

In France, cervical cancer screening is recommended every 3 years for women aged 25-65 years. With the exception of a few local organized programs, screening is mainly opportunistic. In view of setting up a nationwide population-based organized screening program, a pilot intervention was implemented in nine geographic areas using a common protocol. Women aged 25-65 years who had not undergone a cytological screening in the past 3 years were invited for screening during 2010-2012 and reminded up to 1 year after the initial invitation. Cytological results and follow-up data were collected up to the end of 2014 for all women screened irrespective of whether spontaneously or following invitation. Aggregate data were centralized nationally. Among the 2.4 million women from the total target population aged 25-65 years, 1.3 million were invited for screening. The overall screening coverage during 2010-2012 was 62.3%, with wide variations across geographic areas, ranging from 41.6 to 72.5%. Initial invitations and reminders enabled nearly 280 000 women to be screened, corresponding to an estimated increase in coverage of 12% points. Overall, 4.2% of the women screened had an abnormal smear. A total of 5180 high-grade cervical precancers and 323 invasive cervical cancers were reported, corresponding to detection rates of, respectively, 623 and 39 per 100 000 women screened 3-yearly. This study indicates that such organized screening may markedly improve the uptake of cervical cancer screening. On the basis of this pilot program, nationwide organized cervical cancer screening is currently being rolled out in France.

Evaluating the Resources and Need for a Lung Cancer Screening Pilot Program in Maryland

Evaluating the Resources and Need for a Lung Cancer Screening Pilot Program in Maryland