Preventive Services Task Force Research Articles

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.

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

BackgroundThere is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic–pituitary axis. Published studies note that doses...

Agile implementation of alcohol screening in primary care

BackgroundDespite the United States Preventive Services Task Force recommendation to screen adults for unhealthy alcohol use, the implementation of alcohol screening in primary care remains suboptimal.MethodsA pre and post-implementation study design that used Agile implementation process to increase screening for unhealthy alcohol use in adult patients from October 2021 to June 2022 at a large primary care clinic serving minority and underprivileged adults in Indianapolis.ResultsIn comparison to a baseline screening rate of 0%, the agile implementation process increased and sustained screening rates above 80% for alcohol use using the Alcohol Use Disorders Identification Test – Consumption tool (AUDIT-C).ConclusionsUsing the agile implementation process, we were able to successfully implement evidence-based recommendations to screen for unhealthy alcohol use in primary care.

Characteristics associated with early vs. late adoption of lung cancer screening

BackgroundAlthough lung cancer screening (LCS) reduces lung cancer mortality among high-risk individuals, uptake overall remains low. With all cancer screening modalities, a period of diffusion among medical providers and the public is expected, with screening uptake exhibiting a distribution among early vs. late adoption. We aimed to characterize individuals undergoing LCS based upon the timeframe of screening adoption. MethodsThis retrospective study examined patients who underwent LCS between January 2015 – December 2022 in a centralized LCS program. Based on United States Preventive Services Task Force (USPSTF) criteria for LCS, early and late adopters of LCS – defined by time from eligibility to screening completion – were compared. A multivariable regression model was constructed to identify factors associated with early adoption of LCS. ResultsAmong patients screened during the study period, 90.4% were eligible based on USPSTF 2013 criteria, and 9.6% were eligible based on USPSTF 2021 criteria. Of the USPSTF 2013 eligible persons, multivariable analysis demonstrated Black/African-American individuals and current smokers had significantly greater odds of early adoption (aOR 1.428 and 1.514, respectively). Those without a family history of lung cancer or without a personal history of cancer had significantly lower odds of early adoption of LCS. ConclusionsEarly adopters were more likely to report Black/African-American race or current smoking status after adjustment for covariates. Future research should examine how screening diffuses across the overall LCS-eligible population, as well as identify factors that drive and inhibit diffusion to create programs and policies with the ultimate goal of increasing timely LCS uptake.

Evidence From the USPSTF and New Approaches to Evaluate Interventions to Prevent Child Maltreatment.

The United States Preventive Services Task Force (USPSTF) has considered the topic of prevention of child maltreatment multiple times over its nearly 40-year history, each time reaching the conclusion that the evidence is insufficient to recommend for or against interventions aimed at preventing this important health problem with significant negative sequelae before it occurs. In the most recent evidence review, which was conducted from August 2021 to November 2023 and published in March 2024, the USPSTF considered contextual questions on the evidence for bias in reporting and diagnosis of maltreatment in addition to key questions regarding effectiveness of interventions to prevent child maltreatment. A comprehensive literature review found evidence of inaccuracies in risk assessment and racial and ethnic bias in the reporting of child maltreatment and in the evaluation of injuries concerning for maltreatment, such as skull fractures. When children are incorrectly identified as being maltreated, harms, such as unnecessary family separation, may occur. Conversely, when children who are being maltreated are missed, harms, such as ongoing injury to the child, continue. Interventions focusing primarily on preventing child maltreatment did not demonstrate consistent benefit or information was insufficient. Additionally, the interventions may expose children to the risk of harm as a result of these inaccuracies and biases in reporting and evaluation. These inaccuracies and biases also complicate assessment of the evidence for making clinical prevention guidelines. There are several potential strategies for consideration in future efforts to evaluate interventions aimed at the prevention of child maltreatment while minimizing the risk of exposing children to known biases in reporting and diagnosis. Promising strategies to explore might include a broader array of outcome measures for addressing child well-being, using population-level metrics for child maltreatment, and assessments of policy-level interventions aimed at improving child and family well-being. These future considerations for research in addressing child maltreatment complement the USPSTF's research considerations on this topic. Both can serve as guides to researchers seeking to study the ways in which we can help all children thrive.

Plain language summary and patient perspective of the 2020 lung cancer screening recommendations by the US Preventive Services Task Force.

This summary describes the research carried out by the United States Preventive Services Task Force (USPSTF for short) during a review and update of their lung cancer screening recommendations made in 2013. The USPSTF reviewed the results of clinical studies that used a type of scan called low dose computed tomography (LDCT for short). They wanted to see how successful LDCT was at finding lung cancers in people ho hadn't shown any physical signs of lung cancer, but had a history of smoking and were over 50years of age. The review found that performing yearly LDCT scans in people who are at high risk of developing lung cancer is beneficial, as it means that some patients will be diagnosed earlier than they would be without this type of screening. People considered to be at high risk of developing lung cancer include: Adults aged 50 to 80years who have smoked a pack of 20 cigarettes per day for 20years or two packs per day for 10years; OR Adults aged 50 to 80years who currently smoke or have stopped smoking within the last 15years. The information gained from reviewing the research enabled the USPSTF to update their lung cancer screening recommendations.

Comparative Trends in the Distribution of Prostate Cancer Stage at Diagnosis in the Department of Defense Cancer Registry and the Surveillance, Epidemiology, and End Results Data, 2004-2014.

It has been demonstrated that there was an increase in later-stage prostate cancer (PCa) at diagnosis after the U.S. Preventive Services Task Force recommended against prostate-specific antigen screening for prostate cancer. However, the cancer characteristics at diagnosis within the equal-access Military Health System (MHS) during the period have not been described. In this study, we compared PCa stage at diagnosis and its trends between the military health care system and the general public and further compared the trends in tumor stage by race. This study was based on nonidentifiable data from the U.S. Department of Defense's Central Cancer Registry (CCR) and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Patients diagnosed between 2004 and 2014 were included. The distributions of PCa stage at diagnosis over time were compared between the 2 populations. Comparisons were further conducted for White and Black patients, respectively. Among the 11,895 patients in the CCR and 544,142 patients in SEER, the majority of patients were diagnosed with stage I or II prostate cancer. However, the CCR had a larger proportion of early-stage tumors (stages I and II combined) with 84.3% vs. 80.0% of SEER patients. The proportion of late-stage tumors (stages III and IV combined) increased over time from 2008 for both populations and the proportion of early-stage tumors decreased for the general population. In terms of temporal distributions by race, the trends were the same between White and Black groups in the general population. In the MHS, the trends in the White patients were similar to those in the general population, but in the Black patients, the percentages of stages I and II at diagnosis continued to increase and those of stages III and IV decreased, differing from those in the general population. The MHS consistently diagnosed PCa at an earlier stage than the U.S. general population across all time periods evaluated in this study. Although similar trends were observed for White patients between both populations, the proportion of stages I and II at diagnosis increased from 2012 among Black patients in the MHS, which stands in sharp contrast to trends in the U.S. general population. Although the differences between the two populations may be associated with various factors, differences in accessibility to care and thus the use of prostate-specific antigen testing might play an important role.

Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Falls are the most common cause of injury-related morbidity and mortality in older adults. To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.

Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement.

Falls are the leading cause of injury-related morbidity and mortality among older adults in the US. In 2018, 27.5% of community-dwelling adults 65 years or older reported at least 1 fall in the past year and 10.2% reported a fall-related injury. In 2021, an estimated 38 742 deaths resulted from fall-related injuries. The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling adults 65 years or older. Community-dwelling adults 65 years or older at increased risk of falls. The USPSTF concludes with moderate certainty that exercise interventions provide a moderate net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. The USPSTF concludes with moderate certainty that multifactorial interventions provide a small net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians individualize the decision to offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation).

Stage IV non-small cell lung cancer in Veterans undergoing lung cancer screening who were not prescribed statins despite U.S. Preventative Services Task Force recommendations.

e20583 Background: It is well established that Veterans eligible for lung cancer screening (LCS) are also at risk of atherosclerotic cardiovascular disease (ASCVD) due to smoking. Current concepts suggest that statins could play a role in lung cancer prevention and treatment. Accordingly, the purpose of this retrospective, quality improvement project was to determine whether newly diagnosed stage IV non-small cell lung cancer (NCSLC) rate is higher in Veterans undergoing LCS who were not prescribed statins despite U.S. Preventative Services Task Force (USPSTF) recommendations. Methods: Electronic health records of Veterans undergoing LCS and subsequently diagnosed with NSCLC at the Jesse Brown VA Medical Center, Chicago, Illinois between 2021 and 2023 were reviewed. In each case, pertinent demographic, clinical, pathological, and pharmacy data were retrieved. The American College of Cardiology’s ASCVD Risk Estimator was used to assess the Veteran’s 10-year risk for a first ASCVD event. Data are presented as means ± SD. Statistical analysis was performed using Student’s t- and chi-squared tests as indicated. P < 0.05 was considered statistically significant. Results: Out of 57 Veterans diagnosed NSCLC, 33 (all males; 71±6 years; 28 African Americans) were prescribed and 24 (21 males, 3 females; 70±7 years; 18 African Americans) were not prescribed statins. Body mass index was similar in both groups (26.6±6.0 and 26.0±6.0 kg/m2, respectively; p = 0.73). Twenty one out of 24 Veterans (88%) not prescribed statins were eligible according to USPSTF recommendations (10-year calculated risk, 15.23%±6.9%). Stage IV NSCLC was diagnosed in 7/33 (21%) Veterans prescribed statins and in 10/21 (48%) USPSTF-eligible Veterans not prescribed statins (p < 0.05). Conclusions: Clinicians should assess the needfor a statin for primary prevention of ASCVD in each Veteran undergoing LCS. Stage IV NSCLC is more prevalent in Veterans with ASCVD risk who were not prescribed statins despite USPSTF recommendations. A larger, multi-site study is warranted to support or refute these initial observations.

Assessing secular trends in lung cancer stage in the United States community oncology setting from 2013 to 2023.

11178 Background: Detecting disease at an early stage is critical to improving lung cancer (LC) survival, as reflected in guidelines recommending screening with low dose computed tomography for individuals at high risk by clinical societies including the NCCN (2011) and US Preventive Services Task Force (2013, updated 2021). Presenting stage distribution may also be impacted by healthcare utilization changes following the COVID-19 pandemic. Real-world data (RWD)-based investigations are important complements to national cancer registries to provide insight into this potentially changing diagnostic landscape, especially given utilization, practice and referral patterns unique to community settings. We thus assessed LC stage from 2013-23 in a large, nationally representative sample of community oncology practices leveraging RWD. Methods: This is a retrospective observational cohort study of patients within The US Oncology Network and non-Network practices, which include a nationally representative network of over 3,700 providers and more than 1 million patients seen annually in community-based oncology practices. All adult (≥18 years) patients diagnosed with non-small cell LC (NSCLC) or small-cell LC (SCLC) who had a first observed stage available in the community oncology setting within 2013 to 2023 were included. Demographics and medical history data were sourced from structured data fields in iKnowMed, an oncology-specific electronic health record system. Time trends of patient diagnosis and characteristics were descriptively evaluated. Results: The analysis included 98,806 patients with LC (84,023 [85.0%] NSCLC and 14,783 [15.0%] SCLC). Approximately half were female (49.7% and 50.3% in each disease), three-fourths were White (72.7% and 77.0%, respectively), and mean ages at diagnosis were 69.9 and 68.1 years. From 2013 to 2023, there was an increase in the total number of patients observed in the database with a documented stage, from 7,159 to 9,115 (27.3% increase) for NSCLC and from 1,162 to 1,595 (37.3% increase) for SCLC. This was largely driven by an absolute increase in advanced stage diagnoses. The proportion of patients diagnosed with Stage IV NSCLC increased from 43.3% in 2013 to 49.3% in 2023, while the proportions of Stage 0/I and II diagnoses decreased. A similar trend was observed for SCLC, with 60.3% of patients diagnosed with Stage IV in 2013 compared to 68.2% in 2023. The proportion of Stage IV NSCLC cancers increased in the pandemic period, from 48.0% in 2019 to 51.6% in 2020 and 50.6% in 2021. Conclusions: Over the last decade, the proportion of advanced stage LC cases has increased, possibly reflecting changes in referral patterns and utilization specific to the community setting, including those related to the COVID-19 pandemic. The burden of advanced disease highlights the need for continuous investment in advanced-stage treatments as well as early detection efforts.

Budget impact model of LungFlag, a predictive risk model for lung cancer screening.

10534 Background: Lung cancer screening (LCS) programs using low-dose computed tomography (LDCT) for early detection reduce mortality and have been widely recommended. LungFlag is a machine-learning risk prediction model that uses patient-level data to identify individuals at high risk of developing non-small cell lung cancer (NSCLC), prompting their physician to recommend screening with LDCT. Methods: A budget impact model was developed to estimate the costs associated with adoption of LungFlag as an adjunct to existing US Preventive Services Task Force (USPSTF) screening guidelines for a hypothetical US commercial health plan population of 1 million beneficiaries. The model calculates the total expected annual costs of screening for NSCLC with LDCT in scenarios with and without LungFlag, including healthcare resource utilization for detecting NSCLC and treatment of patients diagnosed with NSCLC. Incremental costs were evaluated over a 5-year period. Results: Among 36,803 USPSTF-eligible persons, we assumed that 4600 (12.5%) had already initiated LCS, leaving 32,203 persons who were candidates for pre-screening with LungFlag. The model estimated that 17 additional NSCLC diagnoses per year would be detected by screening when using LungFlag, with most in stage 1. Over 5 years, LungFlag was estimated to result in 33 fewer patients with stage 3 or stage 4 NSCLC at diagnosis and 22 fewer NSCLC-related deaths. Use of LungFlag increased annual costs during the first 2 years and provided cost savings from Year 4 onwards (Table). Cost savings from LungFlag were attributable to reductions in the costs of advanced NSCLC treatment. Conclusions: In a population of 1 million commercial health plan beneficiaries, the adoption of LungFlag as an adjunct to existing screening guidelines for USPSTF-eligible patients was estimated to prevent 22 additional NSCLC-related deaths, with a cost savings of $2.87 million over 5 years from a US commercial payer perspective. [Table: see text]

Pharmacist-Led Deprescribing of Aspirin in Older People in an Outpatient Setting.

Background In 2019, the American College of Cardiology and American Heart Association updated their joint guidelines stating low-dose aspirin should not be used on a routine basis for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among people older than 70 years of age because of increased bleeding risk.1 In addition to these updated guidelines, a statement released by the US Preventive Services Task Force in April 2022 recommends against the initiation of low-dose aspirin for primary prevention of cardiovascular disease in people 60 years of age or older.² Despite these updated recommendations, aspirin continues to be a common medication older patients take, providing an opportunity for a clinical pharmacist deprescribing intervention. Objective To identify the role of a pharmacist-led aspirin deprescribing intervention within a safety-net health system in the outpatient setting. Methods This project included patients 70 years of age and older who had aspirin listed as an active medication without documented ASCVD. This project assessed aspirin deprescribing rates, time spent on pharmacist outreach, and reasons for patient and/or provider refusal to discontinue aspirin. Results One hundred thirty-one eligible patients were contacted. Of those, 78 (60%) patients discontinued aspirin after speaking with the pharmacist, and 8 patients discontinued aspirin after a clinical pharmacist recommendation to the patient's primary care provider (PCP). The median time spent on outreach was approximately eight minutes. Of the 6 patients who consented to the project but declined to discontinue aspirin therapy based on pharmacist intervention, 5 preferred to discuss the issue with their PCP, while 1 patient was told by an outside provider to take aspirin. Conclusion Results indicate the successful impact a clinical pharmacist may have in deprescribing aspirin in a high-risk population. These data may also suggest that an active and intentional approach to deprescribing is likely to be more effective than a written recommendation to providers.

Tamoxifen for breast cancer prevention among survivors of pediatric lymphoma previously treated with chest radiation: Clinical benefits, harms and tradeoffs.

10025 Background: Survivors of pediatric lymphoma previously treated with chest radiation are at high risk for subsequent breast cancer. Although early initiation of breast cancer screening is recommended, the clinical benefits and harms of adding tamoxifen to reduce breast cancer deaths among these women are unknown. Methods: We adapted a Cancer Intervention and Surveillance Modeling Network (CISNET) breast model using data from the Childhood Cancer Survivor Study (CCSS) to reflect the elevated risks for breast cancer and competing mortality for 5-year survivors previously treated with chest radiation (RT). Breast cancer risk was based on age, chest RT field, timing of RT relative to menarche, menopause status, anthracycline exposure, and family history. Premature menopause risk varied by cumulative ovarian RT and alkylator dose. Based on the US Preventive Services Task Force 2019 Evidence Summary, we assumed tamoxifen (20mg daily for 5 years) reduced estrogen receptor positive (ER+) breast cancer risk by 42% (RR = 0.58 [0.42-0.81]) for 20 years and increased risks for venous thromboembolism, deep vein thrombosis, coronary heart disease, stroke and endometrial cancer during treatment. Strategies included no screening or tamoxifen, annual screening with mammography and MRI starting at age 25, annual screening with mammography and MRI starting at age 25 with the addition of tamoxifen at ages 25, 30 or 35. Model outcomes included cumulative breast cancer risk, number of childbearing years before age 45 (defined as years menstruating without tamoxifen use or a breast cancer diagnosis or having survived breast cancer for at least 3 years), and number of tamoxifen-related side-effects. Results: Among a cohort of 20-year-old 5-year lymphoma survivors previously treated with mediastinal RT without primary ovarian failure, an estimated 20% were projected to develop breast cancer and 2.6% would die from the disease before age 50 in the absence of screening or tamoxifen use. Survivors would have on average 22 childbearing years before age 45. Early initiation of breast cancer screening at age 25 would reduce breast cancer deaths before age 50 by 56.3%. Depending on age at initiation, tamoxifen would further reduce breast cancer deaths by 8.0 to 9.6 percentage points for an overall 64.3% to 65.9% reduction and reduce the average number of childbearing years by 17% to 21%. For each breast cancer death averted, a reduction of 1950 to 3740 childbearing life years and 11 to 20 side-effects would occur and varied by the tamoxifen start age compared to mammography and MRI screening. Conclusions: Tamoxifen use for primary breast cancer prevention among pediatric lymphoma survivors may further reduce breast cancer deaths but decisions might depend on survivor preferences for side effects vs. avoiding breast cancer and consideration of timing for childbearing.

Perspectives on clinical adoption barriers to blood-based multi-cancer early detection tests across stakeholders.

e13574 Background: Current United States Preventive Services Task Force (USPSTF) recommendations include routine screening for breast, cervical, colorectal, and lung cancer; however, two out of every three cancer cases occur in other indications leading to diagnosis in advanced stages of the disease and higher likelihood of mortality. Current recommended cancer screening and early detection tests also face several hurdles hindering equitable access in a real-world setting. Blood-based MCED tests can impact cancer screening and early detection by monitoring for multiple different cancer types at once via a blood draw that can detect cancers in multiple indications, including indications where screening is not performed routinely today. Given their nascency, the role of blood-based MCED tests in clinical practice is currently undefined. To help facilitate the appropriate integration of MCED tests into patient care, it is important to understand the perspectives of stakeholders on the anticipated challenges to implementation. Methods: We conducted three separate double-blinded surveys in July 2023 of representative cohorts of U.S. Healthcare providers (HCPs) (n=238) that are or act as primary care providers (general practitioners and obstetrics and gynecologists (OB-GYNs)), payers (n=40), and patients (n=116), to evaluate the current cancer screening and early detection landscape and gather perspectives on barriers to implementation of new cancer screening technologies, including blood-based MCED tests. Results: Of the surveyed HCPs and payers, >90% and 100% respectively reported to be aware of MCED tests. However, <10% of HCPs reported having ordered an MCED test and 80% of payers had not yet evaluated an MCED test for coverage under their plan at the time of the survey. The survey results indicated that there is broad agreement on the value proposition that blood-based MCED tests would improve patient outcomes with earlier intervention. Despite this recognition, the survey highlighted that there is limited use today due to the perceived lack of clinical accuracy and utility data, high out-of-pocket patient costs, and lack of payer coverage. Conclusions: To overcome the hurdles for future widespread adoption of blood-based MCED tests, increased investment in data generation, education, and implementation of logistical support for HCPs will be critical. Initiatives include collaborations between stakeholders to generate near-term clinical utility data, equipping HCPs with the ability to educate patients on test accuracy, and seamlessly integrating the testing process into the patient visit workflow. The findings of this study can help build understanding of the anticipated barriers and inform strategies to alleviate them and build a foundation for clinical adoption of blood-based MCED tests.

Perspectives on Clinical Adoption Barriers to Blood-Based Multi-Cancer Early Detection Tests across Stakeholders.

Current United States Preventive Services Task Force (USPSTF) recommendations include routine screening for breast, cervical, colorectal, and lung cancer; however, two out of every three cancer cases occur in other indications, leading to diagnoses in advanced stages of the disease and a higher likelihood of mortality. Blood-based multi-cancer early detection (MCED) tests can impact cancer screening and early detection by monitoring for multiple different cancer types at once, including indications where screening is not performed routinely today. We conducted a survey amongst healthcare providers (HCPs), payers, and patients within the U.S. health system to understand the current utilization of cancer screening tests and the anticipated barriers to widespread adoption of blood-based MCED tests. The results indicated that the community favors the adoption of blood-based MCED tests and that there is broad agreement on the value proposition. Despite this recognition, the survey highlighted that there is limited use today due to the perceived lack of clinical accuracy and utility data, high out-of-pocket patient costs, and lack of payer coverage. To overcome the hurdles for future widespread adoption of blood-based MCED tests, increased investment in data generation, education, and implementation of logistical support for HCPs will be critical.

E-cigarette use and United States Preventive Services Task Force (USPSTF) lung cancer screening (LCS) eligibility.

10531 Background: Electronic cigarettes (E-cigarettes) have become frequently used as a smoking cessation tool. Emerging research has shown that e-cigarettes have similar carcinogenic effects as combustible cigarettes. While current lung cancer screening (LCS) guidelines primarily rely on individuals’ smoking history, it's becoming increasingly important to understand the prevalence of e-cigarette use among individuals, especially in the context of their LCS eligibility. Methods: Individuals aged 40-80 years were extracted from the 2022 Behavioral Risk Factor Surveillance System. Eligibility was defined using the 2021 USPSTF LCS criteria, i.e., aged 50-80 years who ever smoked, with at least a 20-pack-year smoking history, currently smoke or quit within the past 15 years. We compared the prevalence of current and ever e-cigarette use among LCS-eligible and non-eligible populations, overall and by smoking (combustible cigarettes) status using chi-square tests. All analyses were weighted. The significance level was set at a 2-sided p-value of <0.05. Results: Among the 208,317 individuals included, 9.9% were eligible for LCS. Overall, 3.8% and 22.1% reported current and ever cigarette use, respectively. Fewer LCS-ineligible individuals reported currently using e-cigarettes than their LCS-eligible counterparts (Table). Among former combustible cigarette users, LCS-ineligible individuals were less likely to be current e-cigarette user than LCS-eligible individuals. However, among current combustible cigarette users, LCS-ineligible individuals were more likely to be current e-cigarettes users than LCS-eligible individuals. When examining the prevalence of ever e-cigarette use, similar findings were observed. Conclusions: Our study reveals a significant prevalence of e-cigarette usage among older adults (aged 40-80), with 1 in 5 individuals reporting ever having used e-cigarettes. Moreover, current cigarette users who were ineligible for LCS were more likely to use e-cigarette than their LCS-eligible counterparts. Future epidemiological studies are warranted to assess the risk of e-cigarette use (including intensity, duration and interactions with combustible cigarettes) and lung cancer risks. E-cigarette use may need to be considered in formulating future LCS guidelines. [Table: see text]

Enhancing early detection of lung cancer: A strategic initiative to boost screening rates among patients.

e22512 Background: Lung cancer is the top cause of cancer death in the U.S. Despite LDCT screenings reducing mortality, uptake is low in Alabama and nationally (6% vs. 4.5%). The U.S. Preventive Services Task Force recommends annual LDCT for certain high-risk adults, but factors like awareness, access, and policy affect screening rates. Alabama's situation is worsened by rural disparities and socioeconomic issues. Infirmary Health is the largest private, not for profit health care system in the state of Alabama. This study focuses on evaluating LDCT screening in a selected clinic of our health care system, pinpointing obstacles to adherence, and seeking ways to boost screenings to lower lung cancer mortality through early detection. Methods: As part of the Summer 2023 ASCO Quality Training Program we adopted a QI approach to increase LDCT lung cancer screening. It began by assessing baseline screening rates and staff knowledge, then created problem and aim statements. The team conducted root cause analysis, used a Pareto chart for issue prioritization, and employed a Priority Pay-off Matrix to focus on impactful, feasible issues. The Plan-Do-Study-Act (PDSA) cycle was then used to develop, test, and implement interventions, ensuring strategic alignment and effective monitoring of outcomes to enhance screening rates. Results: From January to July 2023, the Infirmary Health -Hillcrest clinic had a low 10.53% LDCT screening rate (system wide 6%, this clinic was selected due to it's highest screening rate), leading to late-stage lung cancer diagnoses and higher mortality. To address this, a goal was set to triple the screening rate to 30% by December 2023. Key barriers identified were staff and patient knowledge about lung cancer screening and a cumbersome LDCT ordering process. A PDSA cycle initiated between September and December 2023, firstly focused on Patient/Clinic Education, increasing screening rates by simplifying the process—removing doctor signature requirements and enhancing staff knowledge through meetings and informative flyers. The subsequent phase introduced a Nurse Navigator, who further increased screenings through prescreening, staff reminders, and on-site visits. By December of 2023 the LDCT screening rate was increased from baseline 10.53% to 33.3%. Conclusions: Through identifying and addressing key issues like education, faulty process and nurse navigation we successfully elevated LDCT screening rates. This study highlights the benefit of participating in a structured quality training program. [Table: see text]

Lung cancer screening among women Veterans within the Veterans’ Health Administration.

10537 Background: Despite advancements in survival rates, lung cancer remains the leading cause of cancer-related deaths among women in the United States (US). In response to this challenge, the United States Preventive Services Task Force (USPSTF) issued updated guidelines in 2021 to broaden the pool of eligible candidates for lung cancer screening (LCS). Pioneering initiatives, such as the Lung Cancer Screening Demonstration Project (LCSDP) launched by the Veterans Affairs (VA) in 2012, have played a pivotal role in evaluating the feasibility of implementing Low-Dose Computed Tomography (LDCT) at eight Veterans Affairs Medical Centers (VAMC). Subsequently, the program has undergone substantial expansion. Projections within the veteran community indicate a notable increase in the proportion of women veterans, from 11% in 2023 to an anticipated 18% in 2048. However, scant information is currently available regarding the lung cancer screening patterns within this expanding demographic. Methods: Women veterans ages 55 -80, current or former smokers from 2015- 2021 were identified through the VA corporate data warehouse (CDW). ICD 9/10 codes were used to identify women veterans with a lung cancer diagnosis. Diagnoses were verified via chart review. Data were analyzed using R Studio software. Results: Of the women veterans identified (n=44,342), 10,623 received LCS (24%) and 942 (2%) had a primary diagnosis of lung cancer. In the cohort of 942 women diagnosed, 286 (30%) had received lung cancer. Women veterans diagnosed with lung cancer tended to be aged >65 (55%), white (72%), single (72%), unemployed (71%), and urban dwelling (70%) within the southeastern US (35%). Compared to women veterans who did not receive LCS, those who did had higher rates of localized disease (47% vs 34%) and lower rates of metastatic disease (12% vs 19%). Factors associated with higher rates of LCS included mammography (60% vs 49%), a family history of lung cancer (4% vs 2%) and living in the southeastern US (46% vs 35%). It is to be noted that 23% of the women veterans who were screened lived in rural areas and 18.53% identified as black. 98.9% of the women had reported current or former tobacco use but the data on pack year history was missing in 87.6% of charts. Conclusions: While further progress can be made, it is notable that 24% of women veterans received LCS, surpassing national averages. This discrepancy underscores the potential to advance efforts in establishing a comprehensive and structured lung cancer screening initiative, thereby facilitating the equitable inclusion of historically marginalized groups, particularly minorities and rural populations. The findings emphasize the imperative to overcome existing impediments to nationwide enrollment and retention in LCS. Lastly, the study underscores the necessity for increased resource allocation towards tobacco cessation initiatives as an integral component of the broader expansion strategy.

LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.