Preferred Screening Research Articles

Skeptical reactions to breast cancer screening benefits and harms: Antecedents, consequences, and implications for screening communication.

When people receive information about the benefits and harms of mammography screening, they do not always accept it at face value and instead express skepticism. The purpose of this research was to identify the psychological drivers of this skepticism. Two theory-driven hypotheses were considered: One hypothesis proposes that skeptical reactions reflect a psychological defense against information that is emotionally aversive. Another proposes that skeptical reactions reflect a normative probabilistic inference that information that conflicts with prior beliefs is unlikely to be true. This work also identified the potential consequences of skepticism for people's screening preferences. A nationally representative sample of female participants ages 39-49 received information about the benefits and harms of mammography screening. Skepticism toward information about screening benefits and harms was measured, as well as hypothesis-relevant predictors of that skepticism. Participants' preferred age to have regular mammograms was also assessed. The results did not support the hypothesis that skepticism reflects an emotional defense. Instead, skepticism was associated with experiencing the information as conflicting with beliefs and past screening messages. Expressing more skepticism toward screening harms was associated with preferring to start screening at a younger age. These data suggest that people express skepticism toward mammography evidence not because it is aversive information, but instead because it conflicts with other things they believe and have been told. Consistent, coordinated messages from health experts about mammography evidence may therefore help to reduce skepticism, and help promote an informed patient population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adopting Non-invasive Approaches into Precision Colorectal Cancer Screening.

Effective screening is essential to reducing CRC incidence and mortality by detecting the disease at early stages and identifying non-invasive precursors. While colonoscopy remains the most sensitive modality to visualize and remove neoplastic lesions thereby reducing CRC and the related death, its high cost and invasive nature limit its widespread use. The fecal immunochemical test (FIT), which offers a non-invasive alternative with higher public acceptance and comparable cost-effectiveness to colonoscopy, has become the preferred screening method in many regions. Newer non-invasive tests, such as multitarget stool DNA or RNA tests, have shown improved sensitivity for CRC and advanced adenomas, although their high costs and lower specificity present challenges for large-scale implementation. Blood-based circulating cell-free DNA test also offer promise but still require optimization to be cost-effective. The heterogeneity of the screening population further complicates the effectiveness of CRC screening programs. Variations in non-communicable disease risk factors, such as metabolic syndrome, lifestyle habits, and comorbidities, can significantly influence CRC risk and screening outcomes. Moreover, diverse screening behaviors, including inconsistent adherence to recommended screening intervals and the interchangeable use of different screening modalities, add complexity to achieving uniform effectiveness across populations. This variability underscores the need for personalized screening strategies that consider individual risk profiles and screening behaviors, as well as the application of cutting-edge technologies such as big data analytics, artificial intelligence, and digital twin approaches to evaluate its effectiveness. This article reviews the current CRC screening strategies, the advantages of non-invasive methods, and the potential of fecal hemoglobin concentration, to tailor screening intervals and improve risk stratification. It also discusses the emerging role of real-world data and advanced technologies in enhancing CRC screening accuracy and effectiveness, particularly in complex real-world scenarios where traditional methods may fall short. Before novel non-invasive approaches, such as ctDNA tests or polygenic risk scores, are validated and proven cost-effective, exploring the clinical utility of FIT and its quantitative measurement in both screening and surveillance by integrating real-world clinical big data seems a feasible direction for achieving sustained development in population screening.

Implementing Chicken Chorioallantoic Membrane (CAM) Assays for Validating Biomaterials in Tissue Engineering: Rationale and Methods.

Tissue engineering is a promising approach for generating or repairing living tissues. The development of innovative biomaterials for tissue engineering has the potential to address the unmet clinical needs in certain applications. However, before these biomaterials can be used in clinical settings, they must undergo preclinical testing to ensure safety and performance. The chicken chorioallantoic membrane (CAM) assay is a preferred screening tool for studying biocompatibility, angiogenesis, and inflammation induced by biomaterials owing to ethical and economic considerations. This CAM-based platform increased the throughput of biomaterial testing for tissue engineering before invivo testing. In this paper, we discuss the advantages of the CAM model. We also provided a step-by-step guide for implementing the CAM model in a research laboratory, along with tips and tricks for successfully running CAM assays. Finally, we present examples of biomaterials screened using CAM assays. CAM assay is a powerful invivo model for assessing the angiogenic potential of tissue-engineered scaffolds. This guide provides a framework for conducting the assay, but specific experimental conditions should be optimized based on the scaffold material and the research question.

Knowledge About Food Insecurity Among Dental Practitioners: Preliminary Findings From the National Dental Practice-Based Research Network.

Food insecurity is a household-level economic and social condition characterized by limited access to nutritious food. This study explored dental practitioners' views on food insecurity screening and its impact on oral health. A five-question survey ("Quick Poll") was conducted through the National Dental Practice-Based Research Network (PBRN) in the United States. A total of 332 dental practitioners responded. Preferences for food insecurity screening in dental practice settings showed substantial variability: 30% in favor, 39% neutral, and 29% against. When identifying the primary oral health issue influenced by food insecurity, 68% pinpointed dental caries. Over half (53%) expressed comfort in directing patients experiencing food insecurity to relevant resources. Notably, 61% of respondents expressed interest in being involved in future food insecurity clinical studies. This preliminary study underscores the relevance of food insecurity in the professional dental setting and suggests that the clinical setting may be well suited for educational programs designed to improve the oral health of patients experiencing food insecurity. Future research may achieve this goal, including a PBRN clinical study of interventions to improve oral health among patients experiencing food insecurity.

Clinical guidelines for the management of mammographic density: a systematic review of breast screening guidelines worldwide.

High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts. A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument). Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended. Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines.

Pictorial review of hepatic echinococcosis: Ultrasound imaging and differential diagnosis.

Echinococcosis is a zoonotic disease caused by parasites belonging to the genus Echinococcus that primarily affect the liver. The western plateau and pastoral areas of China are high-risk regions for hepatic cystic echinococcosis and hepatic alveolar echinococcosis (HAE). The high late mortality rate associated with HAE underscores the critical need for early diagnosis to improve cure rates and mitigate the disease burden in endemic areas. Currently, the World Health Organization recommends ultrasonography as the preferred initial screening method for hepatic echinococcosis. However, distinguishing between specific types of lesions, such as those of hepatic cystic echinococcosis and HAE, and other focal liver lesions is challenging. To address this issue, contrast-enhanced ultrasound is recommended as a tool to differentiate solid and cysto-solid hepatic echinococcosis from other focal liver lesions, significantly enhancing diagnostic accuracy. In this comprehensive review, we discuss the progression of hepatic echinococcosis and detail the imaging features of various types of echinococcosis using conventional, contrast-enhanced, and intraoperative ultrasound techniques. Our objective is to provide robust imaging evidence and guidance for early diagnosis, clinical decision making, and postoperative follow-up in regions with high disease prevalence.

Correlation of a single-item measure of financial toxicity with overall score.

351 Background: Financial toxicity (FT) refers to the financial burden experienced by patients due to direct and indirect costs associated with their medical care. It has been linked to higher symptom burden, poorer clinical outcomes, quality of life, and psychological well-being and has been shown to extend beyond diagnosis and treatment. Despite the availability of validated tools to measure FT, no single-item screening measure has been validated yet. In the context where time constraints are the most cited reason for patients declining FT surveys, it is crucial to develop efficient tools that allow us to routinely screen patients for FT at different stages of their care. We, therefore, sought to establish item 12 (“My illness has been a financial hardship to my family and me”) of the Comprehensive Score for Financial Toxicity (COST) measure as a well-functioning screening item for FT. Methods: In this secondary analysis of 579 patients who completed a survey on financial toxicity screening preferences, items 1-11 were scored (including reversing 7 items per the version 2 scoring guidelines), with lower scores indicating worse FT. Analyses focused on establishing a correlation with the total score as well as examining item properties. Item 12 was also reverse scored, so lower scores mean greater hardship. Results: Item 12 had an item-total correlation of r = 0.63 (adjusted item-total correlation = .531). Similarly, a linear model with item 12 score as a predictor and total score as the outcome showed that increases of 1 point on item 12 is associated with around 3 total points on the full scale (b = 3.35, p < .001, adjusted R 2 = 0.28. Finally, item analysis with the graded-response item response theory (IRT) model showed very good discrimination (a = 2.10) for item 12, indicating that it can reliably distinguish between low and high FT in patients. IRT results also showed that the item functions as a nearly binary item with responses of “quite a bit” and “very much” corresponding to a high probability of high FT, while responses of “somewhat,” “a little bit,” and “not at all” corresponding to a high probability of low FT. Conclusions: This is the first validation of a single-item screening measure for RT. Overall, these results illustrate that item 12 is a good candidate for a single-item screener, with “quite a bit” and “very much” responses indicating a high likelihood of high FT.

Clinical breast examination: A screening tool for lower- and middle-income countries.

Breast cancer (BC) remains a global health challenge, devastatingly impacting women's lives. Low-and-middle-income countries (LMIC), such as India, experience a concerning upward trend in BC incidence, necessitating the implementation of cost-effective screening methods. While mammography, ultrasonography, and magnetic resonance imaging are preferred screening modalities in resource-rich settings, limited resources in LMICs make clinical breast examination (CBE) the method of choice. This review explores the merits of CBE, its coverage, barriers, and facilitators in the Indian context for developing strategies in resource-constrained settings. CBE has shown significant down-staging and cost-effectiveness. Performed by trained health workers in minutes, CBE offers an opportunity for education about BC. Various individual and health system barriers, such as stigma, financial constraints, and the absence of opportunistic screening hinder CBE coverage. Promising facilitators include awareness programs, capacity building, and integrating CBE through universal health care. No healthcare provider must miss any screening opportunity through CBE.

Abstract A133: The Church Study: Bridging the gap in colorectal cancer screening of Black patients

Abstract Introduction: Colorectal cancer (CRC) is the second leading cause of cancer death in the US, disproportionately affecting Black Americans with a 25% higher risk and 40% greater mortality than non-Hispanic White Americans. Data on CRC screening preferences among Black patients is limited. We conducted a survey to evaluate CRC screening preferences and barriers to screening after a culturally tailored educational talk among Black churchgoers. Aim: The aim of this study is to assess the preferences and barriers to CRC screening among Black Americans, utilizing culturally tailored educational interventions to enhance screening uptake. Methods: Participants aged 45-85, at average CRC risk, were recruited from three predominantly Black churches in disadvantaged areas of Atlanta, excluding high-risk individuals and those outside the age range. CRC education, vetted for cultural sensitivity, was provided. Informed consent was waived by Morehouse IRB but ensured through educational sessions with opportunities for questions. A 30-question survey covered Demographics, Medical History, Screening Experience, and Preferences. Participants received a $25 Amazon gift card post-survey. Descriptive statistics were applied to demographics and CRC screening preferences, categorized per NCCN guidelines. Results: Out of 101 participants, 64% preferred blood-based screenings and 19% preferred fecal-based testing. Over 73% reported being up-to-date with CRC screening, with more than 61% having a colonoscopy as their most recent CRC screening test. Additionally, 30% of participants were willing to be CRC awareness advocates. Healthcare provider access was high, with 94% reporting having a primary care provider. Trust in providers was approximately 92%, with 4% expressing distrust and 4% uncertain. Conclusions: Despite being in underserved areas, participants reported no significant barriers to CRC screening, with most up-to-date on prevention. Their active participation and willingness to advocate underscore the effectiveness of church settings in health education for Black communities. Preferences for blood-based screenings indicate openness to less invasive options, highlighting the need for tailored interventions. High trust in healthcare providers challenges the narrative of mistrust among African Americans, demonstrating that culturally sensitive, community-focused engagement enhances preventive health participation. The willingness of 30% to become CRC awareness advocates demonstrates strong potential for community-driven health initiatives. Citation Format: Toni M. Jackson, John Onyekaba, Kingsley K. Njoku, Ankita Shah, Carrie Smith, Chima Amadi, Kapil Chandora, Daniela Ortegasantori, Hafsa Gundroo, Temitope Tobun, Daniel Hommes, Julia Liu. The Church Study: Bridging the gap in colorectal cancer screening of Black patients [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 A133.

Diabetes screening among women with polycystic ovary syndrome: a descriptive study of commercial claims, 2011–2019

BackgroundPolycystic ovary syndrome (PCOS) is a hormonal disorder that affects 6–12% of United States women of reproductive age. Because women with PCOS are at an increased risk of developing type 2 diabetes, clinical practice guidelines from a number of organizations (e.g. American Diabetes Association, American College of Obstetricians and Gynecologists, US Preventive Services Task Force) recommend that individuals with PCOS are routinely screened for diabetes. Guidelines further indicate that an oral glucose tolerance test (OGTT) should be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is two-fold: 1) to estimate rates of diabetes screening among a nationwide sample of commercially insured women with PCOS and 2) to report the percentage of women screened using each test (OGTT, A1C, fasting plasma glucose) among those who were screened.MethodsWe used the MarketScan Commercial Claims database (2011–2019) to identify a sample of women aged 18–64 years with PCOS who were free from diabetes at baseline and had ≥ 5 years of continuous enrollment in their insurance plan. PCOS was ascertained using International Classification of Disease diagnosis codes (ICD-9: 256.4; ICD-10: E28.2). Diabetes screening was ascertained using Current Procedural Terminology (CPT) codes (A1C: 8303683037; Fasting blood sugar: 82947; OGTT: 82950). Diabetes screening rates were calculated for the overall study sample as well as across subgroups defined by age, overweight/obesity, hypertension, hypercholesterolemia, and vascular disease.ResultsIn our sample of 191,110 commercially insured women with PCOS, 73.40% were screened at least once for diabetes during a five-year period. Among the women screened, 19.24% were screened using the Androgen Excess Society (AES)-recommended OGTT, 61.58% were screened using A1C, and 23.37% were screened using fasting blood sugar.ConclusionsIn a sample of commercially insured individuals spanning the timeframe 2011–2019, nearly 75% of women with PCOS complied with the ACOG screening guidelines for diabetes. Although OGTT is recommended as the preferred screening tool for women with PCOS it was less commonly used than A1C and fasting blood sugar tests.

Financial Toxicity Screening Preferences in Patients With Breast Cancer.

Financial toxicity is an important issue in cancer that affects quality of life and treatment adherence. Screening can identify patients at risk but consensus on appropriate timing or methods is lacking. We sent an anonymous survey to e-mail subscribers of a nationwide breast cancer-specific philanthropic organization in July 2023 asking about financial toxicity screening preferences. Frequencies, percentages, and medians were calculated for categorical and continuous variables. Of 5,774 potential participants, 738 respondents with a confirmed cancer diagnosis participated (12.7% response rate). Participants were 93% female (n = 690), had a median age of 50 years (IQR, 44-57), were 57% non-Hispanic White (n = 418), 20% Black/African-American (n = 149), 9.2% Hispanic (n = 68). 93% confirmed a breast cancer diagnosis (n = 689), and 54% were currently undergoing treatment (n = 400). Most indicated not being asked about financial stressors by (58%, n = 425) and not receiving assistance from their care team (68%, n = 498). Most preferred for providers to reach out regarding financial needs (83%, n = 615). Most wished for these discussions to take place early (when first diagnosed [45%, n = 334] or when treatment selected [37%, n = 275]) and to be asked frequently (each appointment [42%, n = 312] or once per month [36%, n = 268]). Participants felt most comfortable discussing financial needs with a social worker or patient/financial navigator (92%, n = 679), in person (75%, n = 553), or via telephone (65%, n = 479). Patients in this sample primarily consisting of women with breast cancer desired financial screening to occur early, often, and to be initiated by their providers. Patient preferences can inform optimal implementation of financial toxicity screening practices. Continued work refining best practices for financial toxicity screening should incorporate these patient preferences.

Women’s preferences for genetic screening in routine care: A qualitative study

ObjectiveExamine decision-making regarding when women would prefer to receive reproductive carrier and cancer predisposition screening and from what clinician. Methods20 women completed in-depth interviews via Zoom exploring their views on the provision of reproductive carrier and cancer predisposition screening. Our analysis identified themes related to what informs women’s preferences for when they would like to receive a genetic screening offer and by which clinician. ResultsParticipants’ responses to questions about when they would be interested in receiving genetic screening were best understood through the lens of the Extended Parallel Process Model. Specifically, personal utility of the information, a woman’s family health history and cost were key factors in decision-making. Women considered their clinician’s knowledge and their trust in and relationship with the clinician when deciding from whom they would prefer to receive an offer of genetic screening. ConclusionOB/GYN clinic patients may accept an offer of genetic screening from a knowledgeable and trusted clinician for carrier and cancer predisposition screening preconceptionally or prenatally. Practice implicationsIntegrating genetic reproductive and cancer predisposition screening into the care provided to reproductive age OB/GYN patients may be acceptable to this population.

Primary Human Papillomavirus Screening: Women's Perceptions of New Cervical Cancer Screening Recommendations.

Background: Current clinical guidelines recommended primary human papillomavirus (HPV) screening for cervical cancer testing. Previous studies reported patient-level barriers (e.g., limited knowledge and attachment to Pap test) that may hinder wide adoption of primary HPV screening. We assessed these women-level factors following the implementation of primary HPV screening (July 2020) at Kaiser Permanente Southern California (KPSC). Methods: We administered a patient survey (mail and on-line) to female KPSC members aged 30-65 years who received primary HPV screening between October and December 2020. Those who preferred English vs. Spanish language were sampled separately. The survey included domains on knowledge about HPV and HPV screening, awareness of screening guidelines, and attitudes about HPV testing. Demographic data were collected using electronic health records. We used weighted multivariable logistic and modified Poisson regressions for associations between language preference and survey responses. Results: In total, 3,009 surveys were returned (38.0% response rate). Few women (7.0%) found HPV testing as an acceptable screening method. The majority of women (92.2%) remained unaware that HPV testing can replace Pap test for screening. The Pap test was the most preferred screening approach for 33.2% Spanish-speaking women vs. 19.9% English-speaking women. Only 20.6% knew that women aged 30-65 years can be screened every 5 years with cotest or primary HPV screening. Most women (96.4%) did not perceive stigma about taking the HPV test. Conclusion: Proactive patient education will help improve women's knowledge about primary HPV screening, which may facilitate its implementation in additional health care settings.

Impact of Multi-Component Outreach on Colorectal Cancer Screening and Genetic Testing Preferences

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide, with early detection through screening significantly reducing mortality rates. However, disparities in access to screening persist, particularly in disadvantaged communities. Fecal Immunochemical Testing (FIT) offers a cost-effective, non-invasive method that increases screening participation by eliminating the need for in-person visits. Multicomponent outreach strategies are crucial to improving participation rates, particularly in populations with limited healthcare access. Methods: This study employed a mixed-method, sequential explanatory design to assess the impact of a population-based, centralized outreach program on CRC screening rates. Quantitative data from Kaiser Permanente Northern California's (KPNC) screening program were analyzed alongside qualitative ethnographic data to explore the implementation of the FIT-based outreach system. A cohort of individuals aged 51 to 75 years was included, with screening completion rates and follow-up processes examined. Results: Among the community initially screened, 40% participated in CRC screening before intervention. The implementation of a centralized, computerized outreach system led to a significant increase in participation, with screening rates rising by 30 percentage points within eight weeks. A combination of automated phone calls, text messages, and reminders during clinic visits further increased coverage by 12 percentage points, resulting in a total screening participation rate of 80%. The study also found that mailed FIT kits significantly improved participation rates, with FIT mailers leading to a 28-percentage point increase in screening compared to opportunistic testing. Various forms of patient guidance resulted in a 17-percentage point rise in screening, while recall interventions led to a modest 3-percentage point increase. Conclusion: The study demonstrates the effectiveness of a multicomponent, centralized outreach approach in increasing CRC screening participation in a large and diverse population.

Abstract P432: Screening for Primary Aldosteronism: Effect of Test and Cutoff Level on Positivity Rate

Background: The 2016 guidelines of the Endocrine Society proposed a screening test for primary aldosteronism (PA) based on an aldosterone renin ratio (ARR) ≥30. However, a plasma renin activity (PRA) suppressed to <1 ng/mL/h may indicate PA status better than the ARR. Methods: We conducted a retrospective analysis to compare the effectiveness of various screening tests for PA in a cohort of 94,829 consecutive patients who underwent ARR testing at Quest Diagnostics. The tests that were compared include ARR ≥20, ARR ≥30, PRA <1 ng/mL/h, and PRA <0.5 ng/mL/h. This comparison was made because the ARR tests may not be highly sensitive, while the PRA tests may not be highly specific. We also analyzed differences in test volume and positivity rate by region, race, ethnicity, and the time of day when the test was performed. Results: We observed that PRA <1 ng/mL/h identified 2.2 times as many PA cases as ARR ≥20 and 3.3 times as many cases as ARR ≥30. Likewise, PRA <0.5 ng/mL/h identified 1.3 times as many cases as ARR ≥20 and 1.9 times as many cases as ARR ≥30 (Table). We also found that PA positivity rates using ARR ≥20, ARR ≥30, PRA <1 ng/mL/h, and PRA <0.5 ng/mL/h were higher for tests performed before noon than after noon. Additionally, positivity rates were similar across US regions, although the Midwest had lower positivity for ARR tests than PRA tests, and the West had lower positivity for PRA tests than ARR tests. The PRA-based test continued to be positive more frequently than the two ARR-based tests regardless of race; however, non-Hispanic Black patients had a higher positivity rate than Hispanic, non-Hispanic White, and Asian patients, irrespective of the test used. Conclusions: Our data show that compared to PRA <1 ng/mL/h and <0.5 ng/mL/h, the ARR screening tool set at ≥20 or ≥30 potentially misses many patients with PA. If future prospective studies confirm this finding, one of the two suppressed PRA-based tests could become the preferred screening tool for PA.

Shared Decision-Making in Colorectal Cancer Screening for Older Adults

Decisions about whether to stop colorectal cancer (CRC) screening tests in older adults can be difficult and may benefit from shared decision-making (SDM). To evaluate the effect of physician training in SDM and electronic previsit reminders (intervention) vs reminders only (comparator) on receipt of the patient-preferred approach to CRC screening and on overall CRC screening rates of older adults at 12 months. This was a secondary analysis of the Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED) cluster randomized clinical trial. In the PRIMED trial, primary care physicians (PCPs) from 36 primary care practices in Massachusetts and Maine were enrolled between May 1 and August 30, 2019, and were randomized to the intervention group or the comparator group. Patients aged 76 to 85 years who were overdue for CRC screening and did not have a prior diagnosis of CRC enrolled between October 21, 2019, and April 8, 2021. Data analysis was performed between May 24, 2022, and May 10, 2023. Primary care physicians in the intervention group completed an SDM training course and received previsit reminders of patients eligible for CRC testing discussion, whereas PCPs in the comparator group received reminders only. The primary outcome was concordance, or the percentage of patients who received their preferred screening approach. Postvisit surveys were administered to assess patient preference for testing, and electronic health record review was used to assess CRC testing at 12 months. Heterogeneity of treatment effect analyses examined interaction between study groups and different factors on concordance rates. This study included 59 physicians and 466 older adults. Physicians had a mean (SD) age of 52.7 (9.4) years and a mean (SD) of 21.6 (10.2) years in practice; 30 (50.8%) were women and 16 (27.1%) reported prior training in SDM. Patients had a mean (SD) age of 80.3 (2.8) years; 249 (53.4%) were women and 238 (51.1%) reported excellent or very good overall health. Patients preferred stool-based tests (161 [34.5%]), followed by colonoscopy (116 [24.8%]) or no further screening (97 [20.8%]); 75 (16.1%) were not sure. The distribution of patient preferences was similar across groups (P = .36). At 12 months, test uptake was also similar for both the intervention group (29 [12.3%] for colonoscopy, 62 [26.3%] for stool-based tests, and 145 [61.4%] for no testing) and the comparator group (32 [13.9%] for colonoscopy, 35 [15.2%] for stool-based tests, and 163 [70.9%] for no testing; P = .08). Approximately half of patients in the intervention group received their preferred approach vs the comparator group (115 of 226 [50.9%] vs 103 of 223 [46.2%]; P = .47). Heterogeneity of treatment effect analyses found significantly higher rates with the intervention vs the comparator for patients with a strong intention to follow through with the preferred approach (adjusted odds ratio [AOR], 1.79 [95% CI, 1.11-2.89]; P = .02, P = .05 for interaction) and for patients who reported more than 5 minutes (AOR, 3.27 [95% CI, 1.25-8.59]; P = .02, P = .05 for interaction) of discussion with their PCP regarding screening. Higher rates were also observed among patients who reported 2 to 5 minutes of discussion with their PCP, although this finding was not significant (AOR, 1.89 [95% CI, 0.93-3.84]; P = .08, P = .05 for interaction). In this secondary analysis of a cluster randomized clinical trial, approximately half of older patients received their preferred approach to CRC screening. Physician training in SDM did not result in higher concordance rates overall but may have benefitted some subgroups. Future work to refine and evaluate clinical decision support (in the form of an electronic advisory or reminder) as well as focused SDM skills training for PCPs may promote high-quality, preference-concordant decisions about CRC testing for older adults. ClinicalTrials.gov Identifier: NCT03959696.

Improving Colorectal Cancer Screening via Mailed Fecal Immunochemical Testing in a Veterans Affairs Health System.

Colorectal cancer screening rates at the Veterans Affairs Connecticut Healthcare System (VACHS) decreased during the COVID-19 pandemic. Fecal immunochemical testing is recognized as a tier 1 preferred screening method by the US Multi-Society Task Force on Colorectal Cancer. The VACHS implemented a program that mailed fecal immunochemical testing kits to patients to improve colorectal cancer screening rates. This article describes the components of the VACHS patient aligned care team-based mailed fecal immunochemical testing program. Fecal immunochemical testing utilization, completion, and colorectal cancer screening rates at VACHS substantially increased after the implementation of this project. Through a proactive, population-based colorectal cancer screening program centered on mailed fecal immunochemical testing kits outside of a traditional patient visit, VACHS substantially increased the utilization of fecal immunochemical testing kits as well as colorectal cancer screening rates.

When and How to Evaluate Vitamin D Status? A Viewpoint from the Belgian Bone Club.

Low serum vitamin D levels have been associated with a variety of health conditions which has led the medical community but also the general population to evaluate vitamin D status quite liberally. Nevertheless, there remain questions about the efficacy and cost-effectiveness of such a broad and untargeted approach. This review therefore aims to summarize the current evidence and recommendations on when and how to evaluate vitamin D status in human health and disease. For the general population, most guidelines do not recommend universal screening but suggest a targeted approach in populations at risk. Also, some guidelines do not even recommend evaluating vitamin D status when vitamin D substitution is indicated anyway, such as in children or patients receiving anti-osteoporosis drugs. In those guidelines that recommend the screening of vitamin D status, serum 25(OH)D levels are universally proposed as the preferred screening tool. However, little attention is given to analytical considerations and almost no guidelines discuss the timing and frequency of screening. Finally, there is the known variability in diagnostic thresholds for defining vitamin D insufficiency and deficiency. Overall, the existing guidelines on the evaluation of vitamin D status differ broadly in screening strategy and screening implementation, and none of these guidelines discusses alternative screening modes, for instance, the vitamin metabolic ratio. Efforts to harmonize these different guidelines are needed to enhance their efficacy and cost-effectiveness.

Advancing Colorectal Cancer Detection With Blood-Based Tests: Qualitative Study and Discrete Choice Experiment to Elicit Population Preferences.

Colorectal cancer (CRC) is the second most deadly form of cancer, inducing an estimated 1.9 million incidence cases and 0.9 million deaths worldwide in 2020. Despite the availability of screening tests, their uptake remains suboptimal. However, blood-based tests that look for signs of cancer-specific markers in the body are increasingly available as an alternative for more invasive tests for cancer. Compared with existing tests, the benefits of blood-based tests for CRC include not needing pretest preparation, stool handling, and dietary or medication restrictions. This study aims to explore the population's preferences for CRC screening tests, with a focus on blood-based tests, and investigate the factors influencing test uptake. We used a mixed methods approach, combining semistructured interviews and a discrete choice experiment (DCE) survey. Interviews were analyzed using thematic analysis to identify salient attributes for CRC screening tests. These attributes informed the design of the DCE survey. The DCE data were analyzed using mixed logit and mixed-mixed multinomial logit models. Qualitative findings from 30 participants revealed that participants preferred blood-based tests due to their perceived low risk, minimal pain, and ease of sample collection. However, concerns about the test's lower accuracy were also expressed. The DCE survey was completed by 1189 participants. In the mixed logit model, participants demonstrated a stronger preference for blood-based tests over a 2-day stool-based test. The mixed-mixed multinomial logit model identified 2 classes, strong supporters and weak supporters, for CRC screening. Weak supporters, but not strong supporters, had a higher preference for blood-based tests. Women, ethnic Chinese, and people aged 40 to 60 years were more likely to be weak supporters. Both models highlighted the high influence of cost and test sensitivity on participants' preferences. Transitioning from a 2-day stool-based test to a blood-based test, assuming a national screening program at a base price of Singapore $5 (US $3.75), was estimated to have the potential to increase the relative uptake by 5.9% (95% CI 3.6%-8.2%). These findings contribute to our understanding of CRC screening preferences and provide insights into the factors driving test uptake. This study highlights the perceived advantages of blood-based tests and identifies areas of concern regarding their accuracy. Further research is needed to determine the actual increase in uptake rate when blood-based tests are made available.

Mammography Screening Preferences Among Screening-Eligible Women in Their 40s : A National U.S. Survey.

The U.S. Preventive Services Task Force (USPSTF) recently changed its recommendation for mammography screening from informed decision making to biennial screening for women aged 40 to 49 years. Although many women welcome this change, some may prefer not to be screened at age 40 years. To conduct a national probability-based U.S. survey to investigate breast cancer screening preferences among women aged 39 to 49 years. Pre-post survey with a breast cancer screening decision aid (DA) intervention. (ClinicalTrials.gov: NCT05376241). Online national U.S. survey. 495 women aged 39 to 49 years without a history of breast cancer or a known BRCA1/2 gene mutation. A mammography screening DA providing information about screening benefits and harms and a personalized breast cancer risk estimate. Screening preferences (assessed before and after the DA), 10-year Gail model risk estimate, and whether the information was surprising and different from past messages. Before viewing the DA, 27.0% of participants preferred to delay screening (vs. having mammography at their current age), compared with 38.5% after the DA. There was no increase in the number never wanting mammography (5.4% before the DA vs. 4.3% after the DA). Participants who preferred to delay screening had lower breast cancer risk than those who preferred not to delay. The information about overdiagnosis was surprising for 37.4% of participants versus 27.2% and 22.9% for information about false-positive results and screening benefits, respectively. Respondent preferences may have been influenced by the then-current USPSTF guideline. There are women in their 40s who would prefer to have mammography at an older age, especially after being informed of the benefits and harms of screening. Women who wanted to delay screening were at lower breast cancer risk than women who wanted screening at their current age. Many found information about the benefits and harms of mammography surprising. National Cancer Institute.