Preventive Screening Research Articles

Carrier screening for present disease prevalence and recessive genetic disorder in Taiwanese population.

Carrier screening is important to people have a higher prevalence of severe recessive or X-linked genetic conditions. This study is aimed that the frequency and uncertain nature of genetic variants was identified in Taiwanese population, providing individuals with information at risk of inherited diseases and their heritability to newborns. A total of 480 subjects receiving genetic counseling with no family history of inherited disorders were recruited into a cohort from 2018 to 2022. Next-generation sequencing (NGS) panel for autosomal dominant (AD), autosomal recessive (AR) and X-linked diseases was sequenced to assess disease prevalence and carrier frequency for the targeted diseases. Publicly available NGS datasets were analyzed following a tier-based system and ACMG recommendation. 5.3% of subjects showed the presence of variants for genetic disorder, and 2.3% of them were determined with AD. 14 of subjects with pathogenic variants were carriers for AR. The inherited genes were LDLR for AD disorders and AR disorders included GAA and ATP7B. 21.6% of subjects had highest carrier frequency of GJB2 gene. 0.5% of subjects had highest frequency of GJB6 for AR condition. In conclusions, the variants in LDLR, GAA and ATP7B genes were identified in Taiwanese population, indicating individuals had higher risk of Pompe disease, Wilson's disease and familial hypercholesterolemia. Taiwanese individuals carrying GJB2 and GJB6 had the considerable risk of hearing loss passing to their offspring.

Vaikų profilaktiniai patikrinimai pirminėje asmens sveikatos priežiūroje: literatūros apžvalga

Summary. The purpose of the preventive health check-up of children and adolescents is to assess the harmonious development of patients, identify health disorders, and prevent the occurrence of future diseases. In Lithuania, health checks of children and adolescents are carried out periodically. Family doctors or pediatricians, who suspect health disorders in a child during a preventive health check-up, can prescribe all the necessary instrumental or laboratory tests and send the necessary specialists for consultation. In foreign countries, the culture of preventive health check-ups for children and adolescents is somewhat different, as check-ups are not carried out every year.
 A literature review was performed using PubMed and Google Scholar search engines, in the MEDLINE electronic database. The search was carried out from 01.11.2022 to 01.02.2023. The systematic review included 16 articles on the topic. After analyzing the scientific articles, it can be stated that preventive health screening of children and adolescents is carried out in many countries, but with the help of different healthcare professionals and also at different time intervals. Preventive examinations in PSP are carried out by a family doctor, a pediatrician, a nurse, an ophthalmologist, a dentist, and in some countries also a physical medicine and rehabilitation doctor and a psychologist.

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study.

Clinical data has shown that cardiovascular diseases (CVDs) have emerged as a prominent cause of mortality in individuals with hepatocellular carcinoma (HCC). This research aimed to reveal the comorbid effects of CVDs in patients with HCC. The cardiovascular mortality of patients diagnosed with HCC between 2000 and 2014 was compared to that of the general US population. Standardized mortality ratios were calculated to quantify the relative risk of cardiovascular mortality in HCC patients. The cumulative incidence of cardiovascular death (CVD) was estimated using Fine-Gray testing, and independent risk factors for CVD were determined using competing risk models. The results were analyzed using the Kaplan-Meier analysis. The overall SMR for CVD in HCC patients was 11.15 (95% CI: 10.99-11.32). The risk of CVD was significantly higher in patients aged < 55 years (SMR: 56.19 [95% CI: 54.97-57.44]) compared to those aged ≥ 75 years (SMR: 1.86 [95% CI: 1.75-1.97]). This study suggests that patients with HCC are at significant risk of developing CVD. Competing risk analyses indicated that age, grade, tumor size, surveillance, epidemiology, and end results stage, and surgical status were independent risk factors for CVD in patients with HCC. Therefore, patients with HCC require enhanced preventive screening and management of CVDs during and after treatment to improve patient survival.

Vulnerability and Colorectal screening during the pandemic

ObjectiveDisparities in colorectal cancer (CRC) screening prevalence across United States neighborhoods may reflect social inequities that create barriers to accessing and completing preventive health services. Our objective was to identify whether neighborhood social vulnerability was associated with a change in CRC screening prevalence in Boston neighborhoods during the COVID-19 pandemic. MethodsAdults ages 50–74 years due for CRC screening who received primary care at one of 35 primary care practices affiliated with Massachusetts General Hospital or Brigham and Women’s Hospital (Boston, MA), 3/1/2020 to 3/1/2022. The Social Vulnerability Index (SVI) is an aggregate measure of neighborhood social factors often used by public health authorities to examine neighborhood susceptibility to many health outcomes. ResultsIn 2020, 74.9 % of eligible individuals were up to date with CRC screening and this fell to 67.4 % in 2022 (p < 0.001). In 2020, 36.2 % of eligible patients lived in a neighborhood above the 80th percentile of SVI, consistent with high social vulnerability, while the same value was 35.1 % in 2022. There was no association between the change in screening prevalence and SVI: a decrease of 5.5 % screened in neighborhoods with SVI ≤ 80 compared to a decrease of 3.6 % in neighborhoods with SVI > 80 (p = 0.79). ConclusionsThe COVID-19 pandemic equalized the prevalence of CRC screening across Boston-area neighborhoods despite pre-existing geographic disparities in screening prevalence and SVI. Strategies to ensure equitable participation in CRC screening to promote health equity should be considered to promote equitable pandemic recovery.

CAREGIVERS &amp; COLONOSCOPIES: A QUANTITATIVE COMPARATIVE STUDY OF CAREGIVERS’ PREVENTATIVE HEALTH BEHAVIORS

Abstract That many caregivers experience some degree of burden is well-established, but little research has investigated the association of burden on caregiver preventative health behaviors. A lack of adherence to these behaviors, including to recommended colonoscopy and mammography screenings, routine vaccinations, annual clinic visits, and HIV testing, may portend worsening health outcomes for family caregivers if diseases are left undetected or untreated; such outcomes could also be caused by and contribute to the crisis of lack of care to meet demand. Survey questionnaires (N=326) were completed by 214 current caregivers and 112 former caregivers from the national MIT AgeLab Caregiver Panel. Respondents predominately identified as white (88%) and female (83%), with a median age of 40-49 years old. Questions assessed caregiving intensity, health status, reported caregiving burden, and adherence to preventative health screenings and vaccinations (per USPTF age- and gender-based recommendations). Among all caregivers, just 17% reported that they were up-to-date with appropriate preventative health screenings. Current caregivers were less likely than previous caregivers to be up-to-date. Controlling for age, income level, and health status, caregiving intensity (as measured by hours per week) was an independent predictor of adherence to preventative health screenings. These findings suggest that current caregivers who are providing high-intensity care are less likely to be engaging in preventative health behaviors for themselves. This finding is concerning for the future health of these caregivers as well as their care recipients and highlights the need for primary care preventative health initiatives specifically targeting family caregivers.

Prevalence and predictors of cancer screening in transgender and gender nonbinary individuals

Background Current cancer screening guidelines for transgender individuals are guided primarily by expert opinion, and are extrapolated from guidelines for cisgender populations, despite the additional unique risks that transgender populations face in cancer risk and cancer care. Aims We examined adherence to current recommended screening guidelines as well as drivers of cancer screening in 192 transgender and gender-nonbinary (TGNB) individuals participating in Project AFFIRM, a multi-site longitudinal cohort study of TGNB individuals. Methods We used a chi-squared analysis to look for significant associations between predictors and adherence to breast, cervical, prostate and colon cancer screening. We analyzed predictors by 3 different categories: sex/gender identity, healthcare access, and socioeconomic status. Results Screening rates were low for breast, cervical, prostate and colon cancer in TGNB populations compared to national rates for cisgender populations. Among several significant predictors, gender-affirming surgery (hysterectomy) (p-value = <0.0001) and telling others they are transgender at a younger age (< 18) (p-value = 0.0344) were associated with increased screening adherence, while having HIV was associated with decreased screening adherence (p-value = 0.0045). Discussion Our results suggest that interacting with the healthcare system to obtain comprehensive cancer screening can be difficult to navigate among the other healthcare needs of TGNB individuals both on an individual and systems level. Future efforts to mitigate the barriers to screening adherence should be targeted at the healthcare system level.

Toxicology Screening in Sports-Related Sudden Cardiac Death: A Multinational Observational Study

BackgroundKnowledge of toxicological findings among sports-related sudden cardiac death (SrSCD) is scarce. ObjectivesThis study aimed to describe postmortem toxicology findings in a multinational cohort of young SrSCD. MethodsPatients with sudden cardiac death (SCD) aged 12 to 49 years with a complete post mortem were included from Denmark, Spain, and Australia. Postmortem findings were compared between SrSCD and non-SrSCD, and toxicology findings in SrSCD were assessed. ResultsWe included 3,189 SCD, of which 219 (7%) were sports-related. SrSCD patients were younger (36 years vs 41 years; P < 0.001) and of male predominance (96% vs 75%; P < 0.001), and their death was more often caused by structural cardiac disease (68% vs 61%; P = 0.038). Positive toxicology screenings were significantly less likely among SrSCD than non-SrSCD (12% vs 43%; P < 0.001), corresponding to 82% lower odds of a positive toxicology screening in SrSCD. Patient characteristics were similar between SrSCDs with positive and negative toxicology screenings, but deaths were more often unexplained (59% vs 34%). Nonopioid analgesics were the most common finding (3%), and SCD-associated drugs were detected in 6% of SrSCD. SUD was more prevalent among the SrSCD with positive toxicology (59% vs 34%). ConclusionsSports-related SCD mainly occurred in younger men with structural heart disease. They had a significantly lower prevalence of a positive toxicology screening compared with non-SrSCD, and detection of SCD-associated drugs was rare.

A Parametric Time-to-Event Modelling of Recurrent Ischemic Stroke After Index Stroke Among Patients With and Without Diabetes Mellitus: Implementation of Temporal Validation of the Model.

Objectives Compared with the first stroke, neurological impairment caused by stroke recurrence is more serious, more difficult to treat, and has a higher mortality rate, especially among ischemic stroke (IS) patients with diabetes mellitus (DM). Although there are established correlations between factors and IS recurrence, there were some issues regarding the naive hazard of IS recurrence with no risk factor influence, and how does the baseline hazard differ among patients with DM and non-DM? Toanswer all these questions, two time-to-event (TTE) models of recurrent IS after the index IS were developed among IS patients with DM and non-DM. Method A total of 7697 patients with an index IS attack were extracted from the Malaysian Registry of Neurology and stratified according to DM status. Several parametric survival models were evaluated using nonlinear mixed-effect modeling software (NONMEM 7.5). The final model was determined according to the lowest objective function value, graphical evaluation, numerical diagnostics, and clinical plausibility. Additionally, the final model was validated internally and temporally using Kaplan-Meier visual predictive checks (KM-VPCs). Results One hundred ninety-five (5.82%) of 3493 DM patients and 138 (3.28%) of 4204 non-DM patients developed a recurrent IS with a maximum follow-up of 7.37 years. Gompertz's model best fitted the data. With no influence on risk factors, the index IS attack was predicted to contribute to the hazard of recurrent IS by 0.356 and 0.253 within the first six months after the index IS among patients with and without DM, respectively. Even after six months of index IS, the recurrent IS baseline hazard was not equal to zero among both groups (0.0023, 0.0018). Moreover, after incorporating the time and risk factors, the recurrent hazards increased exponentially during the first three years after the index IS followed by an exponential reduction afterward. The recurrent IS predictors among DM patients wereischemic heart disease (IHD) and hyperlipidemia (HPLD). IHD and HPLD increased the hazard of recurrent IS by 2.40 and 1.88 times, respectively, compared to those without IHD and HPLD beforeindex IS (HR, 2.40 (1.79-3.20)), and (HR, 1.88 (1.44-2.45)) respectively. Conclusion The baseline hazard was the highest during the first six months after the index IS. Moreover, receiving medications for secondary prevention failed to demonstrate a significant association with reducing IS recurrence among IS patients with DM, suggesting a need for more intensive patient screening and new strategies for secondary prevention among IS patients with DM.

Cervical Cancer Screening Barriers Among Citizens of Jeddah.

The cervix, a cylindrical structure made of stroma and epithelium, is the lowest point of the uterus. A tissue-proven biopsy of the cervix with histological confirmation is necessary for aberrant cytologic results of Papanicolaou (Pap) smears to rule out cervical cancer. This study investigates barriers to cervical cancer screening among women. A cross-sectional study including 665 Saudi Arabian women residing in Jeddah between the ages of 21 and 65 years was carried out from May to November 2023. A four-part online survey was used to gather the data, which included questions about demographics, cervical cancer screening status, screening barriers, and predictors of cervical cancer screening. The most common barrierto Pap test screening was "have not been to a doctor/no regular provider"(39.7%, N = 251), followed by "lack of provider recommendation/or limited or no information in the community" (30.4%, N = 192) and "low priority/did not perceive need/being healthy" (27.7%, N = 175). The study provides valuable insights into the factors influencing cervical cancer screening in Jeddah, Saudi Arabia. The low prevalence of screening indicates a need for increased awareness and targeted interventions to improve uptake.

Prevalence and determinants of tobacco consumption and oral cancer screening among men in India: evidence from a nationally representative cross-sectional Survey

Prevalence and determinants of tobacco consumption and oral cancer screening among men in India: evidence from a nationally representative cross-sectional Survey

Factors influencing cervical cancer screening among reproductive age group women in India: A multilevel analysis of nationwide survey 2019–2021

Trends and factors associated with cervical cancer screening (CCS) among women of reproductive age are essential for designing cancer prevention strategies to reduce mortality. The present study investigates the factors contributing to CCS in India through multilevel modeling on data from women files of the fifth round of the National Family Health Survey (NFHS- 5). Districts, villages, and individuals were considered as the levels under investigation. Age, contraception use, and wealth index impacted the CCS significantly. The percentage of CCS is 1.2, and it varies across socioeconomic factors. The prevalence of cervical cancer screening is high among women in the 30–49 age group, in the rich wealth index, and not utilizing condoms as contraception. The screening percentage was found to be highest in southern states. A pressing need was felt for organizing awareness camps and all-inclusive dissemination of information, especially in the Northern part of India.

Management of hypertensive disorders in pregnancy: An updated review

Hypertensive disorders in pregnancy (HDP) pose substantial risks to maternal and fetal health. Pre-eclampsia, a globally significant pregnancy complication associated with maternal mortality and adverse outcomes, is on the rise, driven by factors such as obesity, advanced maternal age, and the increasing prevalence of underlying medical conditions. This review explores recent advancements in managing these conditions, extending the scope to encompass cases of hypertension during pregnancy and up to 12 weeks postpartum. Notably, chronic hypertension is now incorporated within the HDP definition, with blood pressure (BP) assessment as a cornerstone in diagnosis. Emphasizing the importance of out-of-office BP measurements, including ambulatory and home-based monitoring, is underscored for pregnant and non-pregnant women. Recent insights into preeclampsia and other HDP have paved the way for enhanced preventive measures, screening protocols, and management strategies. With emerging early detection and intervention tools, there is significant potential for reshaping clinical practices.

The Impact of a Student-Led Health Education Clinic on the Health Literacy and Behaviors of a Rural Community in the State of Pennsylvania, USA.

Rural populations experience a number of disparities that place them at increased risk of morbidity and mortality related to chronic disease, including lower health literacy and greater distance to medical care. Community-based free healthcare education can offer targeted preventive care to these vulnerable populations; however, limited quantitative research exists measuring their impact, specifically on health literacy and likelihood for behavior change. To investigate this, a student-led health education clinic was held in January 2023 in the rural community of Lykens, Pennsylvania by the Student-run and Collaborative Outreach Program for Health Equity (SCOPE). Fifty-five pre- and post-clinic surveys using Likert-style questions measured the knowledge and likelihood of behavioral change for several preventive health topics, including hypertension, diabetes mellitus, cancer screenings, childhood vaccinations, skin cancer, mental health, addiction, and nutrition. From pre- to post-clinic, there was a significant increase in knowledge of hypertension (p = 0.023) and diabetes (p = 0.014), likelihood of attending cancer screenings (p = 0.038), and confidence in identifying cancerous moles (p = < 0.001). There was a non-significant increase in understanding of mental health and nutrition, and no change in understanding of addiction or childhood vaccinations. It is likely that the level of interaction in education provided and relevance of information to participants contributed to effective uptake of information. The results demonstrate an immediate impact on health literacy and likelihood of behavioral change for several important preventive health topics, and advocate for the use of student-run healthcare interventions in addressing the prevalence of chronic disease in rural communities.

Low Awareness of Diabetes as a Major Risk Factor for Cardiovascular Disease in Middle- and High-Income Countries.

Awareness of diabetes as a major risk factor for cardiovascular disease (CVD) may enhance uptake of screening for diabetes and primary prevention of CVD. The American Heart Association conducted an online survey in 50 countries. The main outcome of this study was the proportion of individuals in each country who recognized diabetes as a CVD risk factor. We also examined variation by sex, age, geographic region, and country-level economic development. Among 48,988 respondents, 15,747 (32.1%) identified diabetes as a major CVD risk factor. Awareness was similar among men and women, but increased with age, and was greater in high-income than in middle-income countries. Two-thirds of adults in surveyed countries did not recognize diabetes as a major CVD risk factor. Given the increasing global burden of diabetes and CVD, this finding underscores the need for concerted efforts to raise public health awareness.

Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort.

Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.

Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model

BackgroundWomen living with HIV are at increased risk of developing cervical cancer (CC). Screening for cancer is an important preventive strategy for the early detection of precancerous lesions and its management. There has been inadequate evidence on cervical cancer screening (CCS) practices among HIV-positive women in rural western Uganda. This study aimed to assess the prevalence and predictors of CCS among HIV-positive women, as well as knowledge and practices regarding cervical cancer screening.MethodsA cross-sectional, analytical study was conducted among HIV-positive women attending HIV care facilities located in rural settings of western Uganda. A validated and interview-based data collection form was used to capture statistics regarding demographics, HIV care, obstetric profile, health belief constructs, and knowledge and history of CCS from the participants. Bivariate and multivariate logistic regression analyses were used to correlate women’s characteristics and health beliefs toward CCS practices.ResultsThe prevalence of CCS among HIV-positive women was found to be 39.1% (95%CI: 14.0–71.7). A multivariate logistic regression analysis showed that post-secondary education attainment (AOR = 3.21; 95%CI = 2.12–7.28), four years or more lapsing after being diagnosed as HIV-positive (AOR = 2.87; 95%CI = 1.34–6.13), having more than one child (AOR = 1.87; 95%CI = 1.04–3.35), antenatal care attendance (AOR = 1.74; 95%CI = 1.02–3.43), post-natal care attendance (AOR = 3.75; 95%CI = 1.68–5.89), and having good knowledge regarding CC (AOR = 1.26; 95%CI = 1.98–3.02) were positively associated with adherence to CCS among HIV-positive women in western Uganda. Health Belief Model (HBM) constructs like the perceived risk of developing CC (AOR = 1.82; 95%CI = 1.16–2.01), worries about developing CC (AOR = 5.01; 95%CI = 4.26–8.32), believing that CC leads to death (AOR = 2.56; 95%CI = 1.64–3.56), that screening assists in early identification (AOR = 2.12; 95%CI = 1.84–3.74) and treatment (AOR = 4.63; 95%CI = 2.78–6.43) of precancerous lesions, reducing the risk of mortality (AOR = 1.84; 95%CI = 1.12–2.75), and the reassurance provided by negative test results (AOR = 2.08; 95%CI = 1.33–4.22) were positively associated with adhering to CCS. A female doctor performing the screening (AOR = 2.02; 95%CI = 1.57–3.98) as well as offering a free screening service (AOR = 3.23; 95%CI = 1.99–4.38) were significantly associated with CCS. Meanwhile, screening being painful (AOR = 0.28; 95%CI = 0.12–0.45), expensive (AOR = 0.36; 95%CI = 0.24–0.53), time-consuming (AOR = 0.30; 95%CI = 0.19–0.41), embarrassing (AOR = 0.02; 95%CI = 0.01–0.06), and the fear of positive results (AOR = 0.04; 95%CI = 0.02–0.10) were found to have a significant negative association with adhering to CCS.ConclusionsOnly one-third of HIV-positive women had undergone CCS. Variables including secondary education attainment, four years or more lapsing after being diagnosed as HIV-positive, having more than one child, antenatal care attendance, post-natal care attendance, and knowledge about CC were positively associated with CCS adherence. Educational programs should be geared towards the risk of CC, severity of cases, benefits of screening, and reducing barriers associated with screening, which can significantly improve cervical CCS among HIV-positive women. The study proposes the incorporation of free screening services and the inclusion of trained female staff in CC prevention policies to improve CCS.

Healthcare Inaccessibility of Asian Females in Canada: Barriers to Cancer Preventative Screening

Breast cancer represents a significant issue within the Canadian context, particularly as it pertains to Asian immigrant women who experience comparatively lower rates of mammographic screening. This literature review examines the barriers that impede Asian immigrant women from accessing mammographic screening, with the exception of socioeconomic status, which has been extensively investigated in previous research. The review concludes that the barriers are primarily associated with physician-patient communication and can be categorized into three themes: linguistic, cultural, and knowledge-related aspects. Potential solutions encompass the implementation of customized health education campaigns and the provision of cross-cultural healthcare services, with a particular emphasis on adopting a patient-centered approach to interpersonal contact between healthcare providers and individuals seeking medical care. By effectively tackling these complex problems, interventions have the potential to increase knowledge, facilitate interpersonal exchange, and promote equal opportunities for mammographic screening among Asian immigrant women. This, in turn, can lead to a reduction in the overall burden of breast cancer.

The diagnostic yield of exome sequencing in liver diseases from a curated gene panel

Exome sequencing (ES) has been used in a variety of clinical settings but there are limited data on its utility for diagnosis and/or prediction of monogenic liver diseases. We developed a curated list of 502 genes for monogenic disorders associated with liver phenotypes and analyzed ES data for these genes in 758 patients with chronic liver diseases (CLD). For comparison, we examined ES data in 7856 self-declared healthy controls (HC), and 2187 patients with chronic kidney disease (CKD). Candidate pathogenic (P) or likely pathogenic (LP) variants were initially identified in 19.9% of participants, most of which were attributable to previously reported pathogenic variants with implausibly high allele frequencies. After variant annotation and filtering based on population minor allele frequency (MAF ≤ 10–4 for dominant disorders and MAF ≤ 10–3 for recessive disorders), we detected a significant enrichment of P/LP variants in the CLD cohort compared to the HC cohort (X2 test OR 5.00, 95% CI 3.06–8.18, p value = 4.5e−12). A second-level manual annotation was necessary to capture true pathogenic variants that were removed by stringent allele frequency and quality filters. After these sequential steps, the diagnostic rate of monogenic disorders was 5.7% in the CLD cohort, attributable to P/LP variants in 25 genes. We also identified concordant liver disease phenotypes for 15/22 kidney disease patients with P/LP variants in liver genes, mostly associated with cystic liver disease phenotypes. Sequencing results had many implications for clinical management, including familial testing for early diagnosis and management, preventative screening for associated comorbidities, and in some cases for therapy. Exome sequencing provided a 5.7% diagnostic rate in CLD patients and required multiple rounds of review to reduce both false positive and false negative findings. The identification of concordant phenotypes in many patients with P/LP variants and no known liver disease also indicates a potential for predictive testing for selected monogenic liver disorders.

Abstract B053: Rural-urban disparities in cancer risk factors and screening by United States census region

Abstract We examined rural-urban differences in the prevalence of cancer risk factors and screening behaviors across U.S. census regions to better understand variations within and between geographic regions and inform strategies to address rural cancer inequities. Using an ecological cross-sectional design, we examined rural-urban differences in the self-reported prevalence of county-level cancer risk factors (i.e., obesity, physical inactivity, alcohol consumption) and cancer screening behaviors (i.e., breast, colorectal and cervical) ascertained from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across four U.S. census regions (Northeast, Midwest, South, and West). County-level rurality was defined using 2013 U.S. Office of Management and Budget rural-urban classification codes, and the U.S. Department of Agriculture, Economic Research Service’s rural-urban continuum codes. Chi-square tests assessed differences in the mean prevalence of county-level cancer risk factors and cancer screening behaviors in each geographic region. Analysis of variance (ANOVA) models estimated the p-values for trends in cancer risk factors and screening prevalence across the rural-urban continuum. Within each geographic region, rural counties had a higher prevalence of smoking, obesity and physical inactivity. Yet, rural-urban differences in cancer risk factors were not statistically significant in all geographic regions (e.g., prevalence of obesity for Western rural vs. urban counties was 26.5% vs. 25.7% [p=0.08] and physical inactivity for Northeastern rural vs. urban counties was 23.2% vs. 22.5% [p=0.15]). Moreover, the mean prevalence of obesity was higher in urban areas of the Midwest (31%) and South (31.3%) compared to rural areas in the West (26.5%) and Northeast (29.5%). Binge alcohol use was higher in rural vs. urban counties in the West (19.8% vs. 17.7%; p&amp;lt;0.001) and Midwest (22.3% vs. 21.5%; p=0.006), but lower in the South (13.5% vs. 15.2%; p&amp;lt;0.001). Obesity and smoking prevalence increased with increasing rurality across all regions (ptrend&amp;lt;0.045). Breast, cervical and colorectal cancer screening prevalence were lower in rural vs. urban counties in each geographic region (all p-values&amp;lt;0.04). However, the overall prevalence of screening across all cancer sites was higher in rural Northeast counties compared to both rural and urban counties in the South and West regions. Across all regions, cervical and breast cancer screening decreased with increasing rurality (all ptrend&amp;lt;0.001). A significant inverse trend in prevalence of colorectal cancer screening with increasing rurality was observed in all regions except the Northeast (ptrend=0.17). Our findings suggest notable variations in rural-urban cancer risk factors and screening disparities across U.S. geographic regions. Further exploration of the source of this geographic variation is warranted to ensure the development and implementation of relevant cancer control interventions targeting rural populations most in need. Citation Format: Kelly A. Hirko, Huiwen Xu, Laura Q. Rogers, Michelle Y. Martin, Siddhartha Roy, Kimberly M. Kelly, Shannon M. Christy, Kimlin Tam Ashing, Jean C. Yi, Marquita W. Lewis-Thames, Cathy D. Meade, Qian Lu, Clement K. Gwede, Rachel M. Ceballos, Usha Menon, Katie Cueva, Karen Yeary, Lisa Klesges, Monica L. Baskin, Kassandra I. Alcaraz, Sabrina Ford. Rural-urban disparities in cancer risk factors and screening by United States census region [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B053.

Abstract PR011: Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi

Abstract Background: This study aims to investigate cancer-related knowledge, attitudes, and beliefs among Pacific Islanders and Native Hawaiians in Hawaiʻi by examining social factors that influence healthcare utilization behaviors for cancer screenings. The National Cancer Institute developed the Health Information National Trends Survey (HINTS) to collect national data about the use of cancer-related information, access, as well as changing patterns and communications trends regarding health practices. However, HINTS data are not sufficient to address historically excluded demographic subpopulations as each year, an average of 7,393 Hawai‘i residents are diagnosed with invasive cancer and rates are disproportionate ethnically. Methods: We administered a cross-sectional survey during 2017-2018 to Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling (RDS) to recruit these geographically hard-to-reach groups. The modified HINTS survey included questions about cancer knowledge, attitudes, behaviors, social interactions, and cultural practices. A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer and health-related attitudes, knowledge, and behaviors. The Gelberg and Anderson (2000) Behavioral Model for Vulnerable Populations and biculturalism guided the theoretical and conceptual models for analysis. Logistic regression analysis was used adjusting for age, income, health insurance, and occupational status, to measure social constructs of interest and their interaction with colorectal, pap test, and mammography cancer screenings. To triangulate these findings, key thematic analyses were included from thirteen interviews with adults living within the communities first surveyed. Results: Significant multivariable influences on not having a pap test included never being married (P=.004) and having no health insurance (P&amp;lt;.0001); while influences over having a pap test included a high ethnic identity (P=.001). Significant influences over not having a mammogram included never being married (P=.04), having no health insurance (P&amp;lt;.0001), and not currently employed (P=.009). Significant influences on never having a test for colon cancer included being semi-religious (P=.0001), having no health insurance (P=.005), and not being able to rely on physicians (P=.02). Key findings relating to cancer screenings from the interviews included fear of finding out, lack of language assistance, limited discussion within social circles relating to health and cancer practices, and a belief in a higher intervening power. Conclusion: Cancer prevention education and culturally tailored programs are greatly needed for Pacific Islander and Native Hawaiians in Hawaiʻi. This study provides insight into influences, both positive and negative, on cancer screenings for these communities and areas for future cancer prevention/intervention efforts. Citation Format: Mark L. Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Angelina G. Mummert, Wei Zhang. Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR011.