Preventive Services Task Force Research Articles

Tobacco Cessation: Screening and Interventions.

Tobacco use has been the leading cause of disease and death in South Korea. Early detection of tobacco use and evidence-based interventions play pivotal roles in facilitating tobacco cessation. In accordance with the earlier iterations of the Lifetime Health Maintenance Program (2009) and recent recommendations from the United States Preventive Services Task Force (USPSTF; 2021), two themes were chosen for investigation: the identification of and intervention for tobacco use. The USPSTF recommendations were formulated by conducting an overview of reviews. In this study, literature searches and quality assessments of reviews were conducted. The findings highlighted the efficacy of physician-led identification and advising in promoting tobacco cessation, with robust evidence supporting the implementation of behavioral and pharmacological interventions. These interventions significantly increased the likelihood of successful cessation compared with usual care. Digital interventions, such as internet- or mobile-based interventions, showed additive effects for quitting. Identification and targeted interventions are essential for tobacco cessation. By leveraging evidencebased strategies and enhancing access to resources, healthcare providers can empower individuals to achieve successful tobacco cessation and improve overall health outcomes.

Long-term validation of AtherosSlerosis CardioVascular Disease (ASCVD) risk score and the role of aspirin for primary Cardiovascular prevention in Korean patients with over ASCVD 20% risk score

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death worldwide. The ASCVD risk score can be a great tool for preventing ASCVD in the future. There is a mediation recommendation depending on calculated risk called United States Prevention Services Task Force (USPSTF) aspirin (ASA) recommendation. However, the validation studies of long-term clinical outcomes in Korean population using the ASCVD risk score and of the effect of ASA in Korean patients using USPSTF recommendation are limited. Methods A total of 7,249 patients with any chest pain who underwent coronary spasm provocation tests between January 2004 and December 2021 were enrolled. Patients were divided into four groups, based on the ASCVD risk score: < 5% group (Low Risk, n = 2,534), 5 - 10% group (Borderline Risk, n=1,681), 10 - 20% group (Intermediate Risk, n = 1,896) and ≥ 20% group (High Risk, n = 1,138). The primary endpoint was Major Adverse Cerebral and Cardiovascular Event (MACCE1), including stroke and MACE. The secondary endpoint was MACCE 2, defined as composite of MACE and recurrent angina requiring follow-up coronary angiography (CAG). The third endpoint was the effect of aspirin in patients who have over 20% ASCVD risk. Results Long term (10-year) ASCVD risk score was well-validated from the "Low Risk" group to the "High Risk" group by 1.87%, 7.44%, 14.09%, and 30.61%, respectively (P < 0.001). In baseline characteristics, the calculation factors of ASCVD risk score is also well-stratified, showing the more adverse clinical profiles in the "High Risk" group than the "Low Risk" group. In 10-year clinical outcomes, although MACCE1 and MACCE2 showed an increasing trend numerically, stroke was observed to significantly increase according to ASCVD risk score. There was no effect of ASA prescribed in accordance with USPSTF recommendation. The group with the highest rate of 20% or more failed to show the aspirin prevent effect on the occurrence of CV events, but also increased the incidence (MACCE1; HR: 1.647, P-Value: 0.283, 95% CI: 0.662 - 4.100, MACCE2; HR: 1.819, P-Value: 0.025, 95% CI: 1.078 - 3.068). Conclusion Long term ASCVD risk score was associated with higher risk of stroke. However, MACCE1 and MACCE2 only showed an increasing trend numerically. Furthermore, the effect of ASA prescribed based on the USPSTF ASA use recommendation statement were not observed in Korean population. Consequently, additional research is needed to ensure the utility of ASCVD risk score and the effect of ASA in high-risk patients to prevent future CV events in Korean population.

A 16-year evaluation of opportunistic lung cancer screening with low-dose CT in China: comparative findings between non-smokers and smokers

BackgroundAlthough low-dose computed tomography (LDCT) screening effectively reduces LC mortality in high-risk individuals with a history of smoking in China, the feasibility and efficacy of lung cancer screening (LCS) in individuals who never smoked versus individuals who smoked remains unclear.MethodsWe conducted a retrospective analysis of prospective cohort studies at the National Cancer Center (NCC) in China from January 2006 to December 2022. A comprehensive LCS initiative was undertaken, involving 30,468 participants (54.5% male). Participants underwent LCS using LDCT. Potential malignancies were managed through joint consensus between patients and their physicians. Epidemiology, screening eligibility criteria, and LC detection rates and survival outcomes were compared between individuals who smoked and individuals who never smoked.ResultsAmong 30,468 participants, 339 LCs were pathologically confirmed in 289 patients. The LC detection rate was 0.9% (289/30,468) overall, 0.8% in individuals who smoked (71/9,042), and 1.0% in individuals who never smoked (218/21,426). In individuals who smoked, LC detection rates were 0.5% (21/4516) and 1.1% (50/4526) in the < 20 and ≥ 20 pack-year subgroups, respectively (P = 0.001). Early-stage LC (stage 0 or I) was detected in 73.8% of the individuals who smoked and in 78.8% of individuals who never smoked, while advanced LC (stage III–IV) was found 8.8% of individuals who smoked and 4.2% of individuals who never smoked, respectively. Significant differences in histologic types were found between individuals who smoked and individuals who never smoked (P = 0.01), although adenocarcinoma was the most prevalent in both groups, at 83.0% and 78.8%, respectively. The median nodule size was 9.9 mm (IQR, 8.0–13.8) in individuals who smoked and 9.2 mm (IQR, 6.8–13.6) in individuals who never smoked (P = 0.228). Individuals who never smoked tended to favour surgical treatment alone (88.0%) more than individuals who smoked (81.3%). The 10-year survival rate was higher in individuals who never smoked (92.6%) than in individuals who smoked (88.8%). Only 15.6% (45/289) of patients with LC met the United States Preventive Services Task Force (USPSTF) criteria for LDCT eligibility, while 29.0% (84/289) met the China guideline for the screening and early detection of lung cancer (CGSL) criteria. Median follow-up for those followed was 25.4 (IQR, 13.7–43.3) months.ConclusionsLDCT screening improves early LC detection and treatment outcomes for both individuals who smoked and individuals who never smoked. Significant differences exist in epidemiology, histologic type, and survival between these groups. The USPSTF and CGSL criteria miss a significant number of LC cases, particularly among individuals who never smoked. Integrating individuals who never smoked into LCS programs is essential, yet it comes with its own challenges, such as managing radiation risks, allocating resources effectively, and considering financial aspects. Consequently, there is an urgent need for LCS programs in China to better identify the “high-risk” non-smoker population susceptible to LC and to ensure that potential risks associated with screening are reduced.

Systematic review of clinical effectiveness and safety of abdominal aortic aneurysm screening in men

Abstract Background Abdominal aortic aneurysm (AAA) is characterised by a bulging in the aortic wall. AAA is typically asymptomatic until aneurysm rupture, which is associated with a very high mortality rate (approximately 80%). In the context of an ageing population and increasing life expectancy, innovative approaches to early detection and intervention are needed. The aim of this review was to assess the clinical effectiveness and safety of one-time ultrasound screening for AAA in men. Methods Systematic searches were conducted in electronic databases and grey literature sources. The primary outcomes of interest were AAA-related mortality, AAA rupture, all-cause mortality, rate of surgical repair and safety. The following study designs were included: systematic reviews, randomised controlled trials (RCTs), comparative observational studies and population-based non-comparative observational studies. Results Results from a systematic review by the US Preventive Services Task Force analysed 4 population-based RCTs, showing that one-time population-based screening for AAA in men (≥ 65 years) led to significant reductions in AAA-related mortality (OR = 0.65, 95% CI: 0.57 to 0.74), AAA rupture (OR = 0.61, 95% CI: 0.54 to 0.69) and emergency surgeries (OR = 0.53, 95% CI: 95% CI: 0.44 to 0.64) at 13-15 years follow-up, relative to no screening. Separate to this systematic review an additional 24 studies reported on clinical effectiveness, safety and psychosocial harms of AAA screening. Limited evidence from these studies suggest screening was associated with a reduction in AAA-related mortality and rupture but also transient psychological distress in some cases. Conclusions One-time ultrasound screening in men ≥65 years appears to offer benefits in terms of reducing AAA ruptures and AAA-related mortality, though the balance of benefits and harms requires careful consideration. In an ageing population, AAA screening could be transformative, by reducing mortality and rupture risks. Key messages • One-time ultrasound screening for AAA in older men (≥ 65 years) can reduce AAA-related mortality and rupture. • In the context of an ageing population in Europe, AAA screening could be transformative, but benefits must be weighed against potential risks.

Cervical Cancer Screening: Patient Perspectives on Transitioning to Primary High-Risk Human Papillomavirus Testing Alone.

In 2018, the US Preventive Services Task Force updated cervical cancer screening recommendations to allow for screening every 5 years with primary human papillomavirus (HPV) testing in combination with cytology (cotesting) or every 5 years with primary HPV screening alone. Despite these changes, the uptake of primary HPV screening has been lower than expected. The purpose of this study was to evaluate the patient perspective of an integrated health system transition from cotesting to primary HPV testing among a 30- to 65-year-old cohort. Semistructured phone interviews were conducted from July to December 2023 at Kaiser Permanente Colorado with 16 members aged 30-65 years. Interviews asked about reactions to the forthcoming change in cervical cancer screening, personal concern about cervical cancer risk, feedback on patient-facing education materials, and preference on communication timing and modality. Participants reported concerns about cervical cancer screening intervals, primarily the reduction in frequency leading to underdiagnosis of sexually transmitted infections (STIs). Participants recommended defining the rationale for the change to primary HPV testing in the patient education materials. Participants preferred communication about the change in-clinic between practitioner and patient. The interviews identified key themes, including the differentiation between cervical cancer and STI screening methodologies, potential underdiagnosis of STI and cervical cancer, and the rationale supporting primary HPV testing and associated screening intervals. These qualitative findings can inform health systems of potential patient concerns to address when considering the transition from cotesting every 3 years to primary HPV testing every 5 years for cervical cancer screening.

Cluster randomized trial of a team communication training implementation strategy for depression screening in a pediatric healthcare system: a study protocol

BackgroundPediatric depression is a global concern that has fueled efforts for enhanced detection and treatment engagement. As one example, the US Preventive Services Task Force recommends depression screening for adolescents ages 12–18 years. While many health systems have implemented components of depression screening protocols, there is limited evidence of effective follow-up for pediatric depression. A key barrier is timely team communication and coordination across clinicians and staff within and across service areas for prompt service linkage. However, team effectiveness interventions have been shown to improve team processes and outcomes and can be applied in healthcare settings.MethodsThis project aims to refine and test a team communication training implementation strategy to improve implementation of an existing pediatric depression screening protocol in a large pediatric healthcare system. The team will be defined as part of the study but is expected to include medical assistants, nurses, physicians, and behavioral health clinicians within and across departments. The implementation strategy will target team mechanisms at the team-level (i.e., intra-organizational alignment and implementation climate) and team member-level (i.e., communication, coordination, psychological safety, and shared cognition). First, the project will use mixed methods to refine the team training strategy to fit the organizational context and workflows. Next, a hybrid type 3 implementation-effectiveness pilot trial will assess the initial effectiveness of the team communication training (implementation strategy) paired with the current universal depression screening protocol (clinical intervention) on implementation outcomes (i.e., feasibility, acceptability, appropriateness, workflow efficiency) and clinical/services outcomes (increased frequency of needed screening and reduced time to service linkage). Finally, the study will assess mechanisms at the team and team member levels that may affect implementation outcomes.DiscussionTeam communication training is hypothesized to lead to improved, efficient, and effective decision-making to increase the compliance with depression screening and timely service linkage. Findings are expected to yield better understanding and examples of how to optimize team communication to improve efficiency and effectiveness in the pediatric depression screening-to-treatment cascade. This should also culminate in improved implementation outcomes including patient engagement critical to address the youth mental health crisis.Trial registrationNCT06527196.Trial Sponsor: University of California San Diego.

12453 Osteoporosis Screening In A Primary Care Clinic: Barriers And Solutions

Abstract Disclosure: B.M. Laquidara: None. S. Mistry: None. L. Guo: None. Purpose/Objective: Osteoporosis is a prevalent bone disorder that affects over 10 million people in the United States. The US Preventive Services Task Force (USPSTF) recommends screening females aged 65 and older with a baseline DEXA scan and to screen postmenopausal females younger than age 65 who have an increased risk of osteoporosis. Despite these guidelines, the screening rate for osteoporosis remains very low. Our quality improvement project seeks to first identify at what rate eligible patients in our residency primary care clinic are being screened for osteoporosis and what barriers (patient, provider, or clinical factors) to screening may decrease this rate. Methods: We reviewed a random sample medical records of 300 female patients aged &amp;gt;/= 50 years who visited our clinic within the last two years. We collected patient demographics, insurance status, presence of ≥1 risk factor of osteoporosis (fracture, heavy alcohol use, tobacco use, steroid use, BMI&amp;lt;19), MyChart activity, provider training level, diagnosis code, and whether a baseline DEXA was ordered and/or completed. We compared patient characteristics by DEXA order status using descriptive statistics, and used multivariable regression models to determine odds of DEXA order and completion. Results: The patients who were at high risk for osteoporosis were more likely to have an order without completion (OR 6.11, p &amp;lt;0.001). Increased age was associated with increased odds of having an order (OR 1.09, p&amp;lt;0.001). Increasing BMI was associated with decreased odds of having an order. Black patients and current smokers were less likely to have a DEXA scan ordered and completed after controlling for age and other confounding factors (p= 0.002 and 0.001 respectively). Among the 96 patients who had a completed DEXA scan, 74 had osteoporosis. The only significant predictor for having osteoporosis was low BMI (OR 0.87%, p&amp;lt;0.001). Conclusion: The results of this study suggest that while patients with a clinically high risk for osteoporosis are more likely to have an order placed for a DEXA scan, these patients often do not have a completed scan. Patients who have an ICD-10 diagnosis of high-risk for osteoporosis or osteoporosis in their electronic medical record are more likely to have both an ordered and completed scan. Utilizing this data, we will develop a variety of interventions such as a clinical didactic case for osteoporosis, a flow-sheet summary of proper osteoporosis screening and treatment initiation to be distributed in the clinic setting, and a short presentation during noon didactics where we review the proper screening method for osteoporosis. Following our intervention, we will re-examine the screening rate in our residency clinic to evaluate the effect of our intervention. Presentation: 6/3/2024

9397 Shatter Proofing Bones: Revamping Osteoporosis Screening

Abstract Disclosure: R. Subramani: None. T. Gupta: None. M. Anwar: None. J. Pamula: None. Background: Osteoporosis is a common disease characterized by low bone mass, structural deterioration of bone tissue, and increased risk of fractures. The World Health Organization (WHO) has defined osteoporosis based on bone density measurements. According to their definition, osteoporosis is diagnosed when the bone density at the hip or spine is at least 2.5 standard deviations (SDs) below the mean bone density of a reference population of young, healthy women (T score ≤ -2.5). According to NHANES data from 2017-2018, the overall prevalence of osteoporosis among adults over 50 was found to be 12.6%. It was observed that the prevalence of osteoporosis was higher among women (19.6%) compared to men (4.4%). According to US Preventative Services Task Force (USPSTF), the guidelines for screening are as follows: BMD Testing (DEXA) for all women aged 65 and older, postmenopausal women younger than 65 with clinical risk factors for fracture including advancing age, previous fracture, glucocorticoid therapy, parental history of hip fracture, low body weight, current cigarette smoking, excessive alcohol consumption, rheumatoid arthritis, secondary osteoporosis. BMD Testing for Men is not recommended. The most used bone measurement test to screen for osteoporosis is central DXA which measures BMD at the hip and lumbar spine. Goal: To improve the osteoporosis screening using DXA scan in the outpatient internal medicine resident patient panel by 5% Study Design:Subjects were identified by an EPIC report and will include retrospective chart review of records from July 2022 and prospective screening until April 2024 for the outpatient IM clinic list of patients including both resident panel. Methods: Pre-intervention data analysis of current rates; Educating residents about appropriate screening; Utilization of osteoporosis screening as care-gap in EPIC ;Calling patients who are due for screening from IM residents patient panels; Post-interventional data analysis Results: The total number of patients on the residents panel was 196. Before interventions, screening rate for osteoporosis were 71.2% among residents' patients. After intervention, screening rates increased to 75.5%. There was a 4.3 % improvement in screening rate. Conclusion: Resident education, addressing Osteoporosis care gaps in EPIC and patient outreach are effective interventions to improve screening rates. Discussion: Osteoporosis screening remains an area of needed improvement in IM clinic. EPIC system should not only take age for prompting osteoporosis screening but also other factors such as family history, pre-mature fractures, steroid use, etc. Adding osteoporosis screening into the metric system are few steps to be considered for future directions. Presentation: 6/3/2024

Quality improvement of breast and cervical cancer screening satisfaction rate at a resident-led clinic.

308 Background: In the US, 77.3% of women aged 21-65 years have had a Pap smear within the past three years and around 75.9% of women aged 50-74 years reported having a mammogram within the past two years as recommended according to the U.S. Preventive Services Task Force (USPSTF). In UTRGV Resident-led Clinic located in Hidalgo County, the quality metrics data demonstrated screening satisfactory rate for cervical and breast cancer to be 18% in August 2023. This Quality Improvement project is aimed at enhancing the screening satisfactory rate of breast and cervical cancer by 20% at UTRGV Knapp IM Clinic by December 2023. Methods: First, we focused on the education of the residents through noon conference and 1:1 education. This included comprehensive instruction on latest USPSTF guidelines and proper documentation on the electronic health record system, Athena. Second, we introduced a patient screening questionnaire, available in both English and Spanish. These efforts were evaluated through a pre-and-post-intervention survey designed to assess changes in residents' confidence, aligning with quality metrics data. We obtained and filtered the quality metrics raw data to include all the current residents in PGY1-3 and summed the number of patients who had records of breast and cervical cancer screening and divided the sum of all patients that required the record. The satisfaction rate was rounded to the 2nd decimal place. Results: The raw data from 8/2023 showed screening satisfactory rate for cervical and breast cancer to be 18%. With the initiation of intervention, the data from 9/2023 showed rate of 35%, finally reaching 39% on 12/2023, fulfilling our aim of 20% increase in the screening satisfactory rate. Survey data shows that there was an improvement of confidence observed in both breast and cervical cancer screening. Respectively, 27.5% and 30.9% increase in the residents who responded confident in breast cancer and cervical cancer screening were observed. 84.4% of residents responded that they are less forgetfulness in screening patients after the intervention. There was 22.9% increase in residents who know how to record the cancer screening result in Athena. 87.5% of the residents responded that they experienced improvement in implementing and documenting the breast and cervical cancer screening. Conclusions: Despite several limitations in acquiring and analyzing the data, this QI project positively impacted both subjective and objective data for the improvement of the breast and cervical cancer screening, fulfilling our aim of 20% increase in screening satisfactory rate by December 2023. Breast and cervical screening satisfactory Rate. Month/year Number of patients requiring breast and cervical cancer screening Number of patients with satisfaction in breast and cervical cancer screening Satisfactory rate (%) 08/2023 42 229 18 9/2023 999 2844 35 10/2023 454 1458 31 11/2023 649 1771 37 12/2023 113 287 39

USPSTF Colorectal Cancer Screening Recommendation and Uptake for Individuals Aged 45 to 49 Years

In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown. To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021. This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022. Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years. Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality. In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods (P < .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, -30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, -30.91% to 461.15%] vs 167.73% [95% CI, -16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months). This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.

Assessing capacity for hereditary cancer risk assessment in metro Chicago.

307 Background: Since 2005, the United States Preventive Services Task Force (USPSTF) recommends that primary care (PC) clinicians identify and refer adults with a high-risk cancer family history to cancer genetic services (CGS), yet hereditary cancer risk assessment (HCRA) continues to be underutilized in PC. A population-based approach to HCRA in PC settings can expand access to cancer prevention and early detection to vulnerable populations and reduce disparities in cancer outcomes. The Chicago Cancer Screening and Testing Access Coalition (CCSTAC) is developing strategies to integrate HCRA in PC settings. We conducted an environmental scan to assess current capacity to deliver 1) HRCA in Federally Qualified Health Centers (FQHCs) and 2) follow-up CGS for high risk patients. Methods: In 2023, we administered two surveys to assess HCRA practices in Metro Chicago. We invited 22 FQHCs to complete a 21-item survey of current practices, readiness to implement, and barriers to HCRA. We also invited 21 CGS sites to complete a 25-item survey to understand staffing, utilization, referral patterns, and barriers to access. Surveys were administered electronically via Qualtrics. We conducted a descriptive analysis of survey data. Results: Twenty FQHCs (91%) completed the survey on HCRA in PC; 85% reported familiarity with USPSTF guidelines for HCRA. The majority (75%) reported no plans to implement HCRA. Clinic workflow, paucity of follow-up resources, cost, lack of provider knowledge, and absence of HCRA as a mandatory performance measure were cited as the most significant barriers to implementation. Genetic counselors (GCs) from 19 CGS hospital-based sites (90%) completed the survey on availability of genetic services. CGS were most often located in a cancer center (47%); no CGS were located in PC. Most referrals originated from oncology, surgery, or gastroenterology, with the lowest rate of referrals from community-based PC. Nearly half of CGS clinics (47%) reported capacity for at least a small increase in patient volume. Wait-time at the majority of CGS clinics was less than a month. GCs cited patient logistics (e.g. transportation, time off work), lack of referral information from providers, and systemic racism as significant barriers in patient access to CGS. Conclusions: After almost 20 years of evidence-based guidelines, use of HCRA is still very limited in the community-based PC setting. Our findings point to a need to bridge the gap between hospital-based CGS and FQHCs to ensure patients in vulnerable communities have access to guideline-concordant cancer prevention and screening strategies. Based on these findings, CCSTAC is designing strategies to integrate HCRA in primary care at FQHCs focused on provider education, well-designed clinic workflows, connections with existing CGS, and advocacy to align UDS and HEDIS measures with USPSTF guidelines.

Associations of individual and partner incarceration history and receipt of cancer screening in the US.

50 Background: Incarceration history is linked to limited access to care, including cancer screenings. Adverse consequences may also extend to their partners due to financial burdens and social stigma. This study examined associations of individual and partner incarceration history and receipt of cancer screenings in the United States. Methods: We identified individuals aged ≥ 50 years currently living with a partner who responded to the 2014-2020 Health and Retirement Study. Incarceration history was defined from responses to the question ‘Have you ever been an inmate in a jail, prison, juvenile detention center, or other correctional facility?’ People were categorized into 3 groups: 1) without individual or partner incarceration history, 2) with individual incarceration history only, and 3) with partner incarceration history only. People with both individual and partner incarceration history were excluded due to small sample size. We used multivariate logistic regression models to generate prevalence ratios (PRs) comparing receipt of any breast, cervical, and colorectal cancer screenings ≤2 years among screening-eligible people (defined by the US Preventive Services Taskforce guideline) with individual or partner incarceration history to people without incarceration history, stratifying by sex and controlling for age group, race and ethnicity, educational attainment, and comorbidity. Results: Of the sample, 0.9% and 11.8% of females and males reported individual incarceration history, respectively; 11.1% and 1.0% reported partner incarceration history, respectively. Compared to females without individual or partner incarceration history, women with partner incarceration history were less likely to receive breast cancer screening (PR:0.7, 95CI: 0.5-0.9); women with individual incarceration history were less likely to receive colorectal cancer screening in the past 2 years (PR: 0.7, 95% CI: 0.5-0.9). Compared to males without individual or partner incarceration history, men with partner incarceration history were less likely to receive colorectal cancer screening (PR: 0.5, 95% CI: 0.4-0.7). Conclusions: Individual or partner incarceration history was associated with lower prevalence of cancer screening. Programs to improve access to care and cancer screening among both people with incarcerations history and their partners are warranted. Adjusted association of individual and partner incarceration history and receipt of cancer screening. Female Male No Individual or Partner History With Individual History With Partner History No Individual or Partner History With Individual History With Partner History Cancer screening Breast (n=2556) Ref. 2.0 (0.5 - 8.3) 0.7 (0.5 - 0.9) -- Cervical (n=817) 1.4 (0.4 - 5.6) 0.9 (0.6 - 1.4) Colorectal (n=2682 for female, n=2207 for male) 0.7 (0.5 - 0.9) 0.9 (0.7 - 1.0) Ref. 1.0 (0.9 - 1.2) 0.5 (0.4 - 0.7) Ref: referent group.

Survival of lung cancer patients according to screening eligibility using Korean Lung Cancer Registry 2014–2016

This study assessed survival for lung cancer patients meeting criteria for the National Lung Cancer Screening Program in Korea launched in 2019 and updated guideline reported by the US Preventive Service Task Force (USPSTF). We assessed all-cause mortality based on the Korean Lung Cancer Registry (KLCR), including lung cancer patients diagnosed in 2014–2016. We compared survival among lung cancer patients eligible for extended USPSTF criteria (age 50–80 years and ≥ 20 pack-years) and those meeting current criteria (age 54–74 years and ≥ 30 pack-years, current or within the past 15 years). The nearest neighbour propensity-score matching was performed to generate a matched set. Kaplan–Meier curves were generated to compare survival among groups; differences in survival were analyzed using the stratified log-rank test. The mortality risk was estimated based on a Cox proportional hazards regression model and the robust standard error was calculated. Of 8110 patients, 37.4% and 24.3% met the extended USPSTF eligibility criteria and National Lung Cancer Screening Program (NLCSP) criteria, respectively. Overall mortality risk was not significantly different between the extended younger age group and the NLCSP group (hazard ratio [HR] [95% confidence interval (CI)]: 0.78 [0.59–1.02]). The extended older age group had a significantly higher mortality risk (HR [95% CI]: 1.41 [1.26–1.58]). Mortality risk was not significantly different between patients who smoked 20–29 pack-years and those who smoked ≥ 30 pack-years (HR [95% CI]: 0.90 [0.79–1.03]). Lung cancer patients aged 50–53 years and those with a 20–29 pack-years smoking history exhibited similar mortality risk to individuals meeting current criteria, while patients aged 75–80 years were at a higher risk of death. Although we verified similar or higher mortality risks in extended subgroups, a careful assessment of the benefits and harms of the screening tests is necessary when contemplating the extension of criteria.

The US Preventive Services Task Force in Legal Jeopardy

This work discusses the Braidwood Management Inc v Becerra case and how the intent of Congress, the health of the public, and the law may come into conflict.

Igniting Awareness: Assessing Healthcare Providers' Understanding of Firefighter Cancer Risks

Firefighters are at increased risk for skin cancer from exposure to fireground carcinogens, UV radiation, and other occupational hazards. Despite known risk factors, agencies such as the US Preventive Services Task Force (USPSTF) do not include recommendations for routine skin cancer screenings in their general guidelines. Moreover, limited provider understanding of the unique health challenges firefighters encounter has resulted in a lack of awareness in the healthcare community regarding these increased skin cancer threats. This raises concern as providers are crucial in conducting skin cancer screenings and advocating for preventive measures for patients, especially firefighters. To better understand healthcare provider perspectives, the San Antonio Fire Department (SAFD) administered a questionnaire assessing healthcare providers’ knowledge of firefighter cancer, including rates, risks, and policies, to healthcare providers attending the second annual SAFD “Firefighter Cancer Prevention and Wellness Fair” in January and February 2024, sharing de-identified results with the research team. The results indicate a majority of healthcare providers have limited knowledge about skin cancer in firefighters and are unaware of the major risks affecting members of this occupation. Approximately 70 healthcare providers participated in the questionnaire; of those, 4% passed the basic firefighter cancer knowledge quiz (&gt;70% correct answers) and 18% scored higher than 50%. The mean score was 34%. While the SAFD skin cancer screenings revealed a smoldering knowledge gap among providers in understanding firefighter cancer risk, this study underscores the necessity of educating more healthcare professionals about the men and women who dedicate their lives to keeping ours safe.

Abstract A016: Understanding the Impact of Numerous Cancer Prevention Guidelines on Public Adherence

Abstract Background: Organizations like the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) have developed comprehensive cancer prevention guidelines focusing on nutrition, physical activity, cancer screening, and vaccination with a goal of reducing cancer incidence and improving cancer health outcomes. However, the abundance and complexity of these guidelines can lead to public confusion and potentially hinder adherence. This study investigates public perception of the multitude of cancer prevention guidelines and their potential impact on compliance. Methods: Data were derived from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4, 2020), conducted via a mail survey from February to June 2020. We examined public perception about cancer prevention recommendations and if the number of recommendations made it more difficult to determine which ones to follow. Multivariable Logistic regression was used to examine the factors that are associated with agreement with the statement: “there are so many different recommendations about preventing cancer, it's hard to know which ones to follow.” Results: Survey respondents consisted of 3,747 U.S. adults. Approximately 74.1% of respondents agreed with the statement, "There are so many different recommendations about preventing cancer, it's hard to know which ones to follow." Non-Hispanic Black respondents had the highest proportion of agreement (80.6%) Level of education was statistically significantly associated with agreement with the statement "there are so many different recommendations about preventing cancer, it's hard to know which ones to follow." As education level increased, the odds of agreeing with the statement decreased. Specifically, college graduates (aOR 0.58; 95% CI: 0.36-0.94), and those with postgraduate education had an aOR of 0.38 (95% CI: 0.22-0.67). Conclusion: The study highlights significant public perception challenges regarding the abundance of cancer prevention guidelines. These findings suggest a need for streamlined communication and education strategies to enhance guideline adherence and optimize cancer prevention efforts. Citation Format: Tochukwu Nzeako, Onyema Chido-Amajuoyi. Understanding the Impact of Numerous Cancer Prevention Guidelines on Public Adherence [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 A016.

Abstract A145: Race and sex disparities in lung cancer screening and evaluation of alternative identifiers in patients’ electronic medical record to better identify lung cancer screening candidates

Abstract Introduction: The US Preventive Services Task Force (USPSTF) recommends lung cancer screening with a low dose CT scan in patients who are 50 – 80 years old with at least a 20 pack-year smoking history and currently smoke or quit in the last 15 years. Yet, only 5.8 percent of eligible Americans were screened in 2022. We investigated demographic screening patterns and evaluated for alternative identifiers in patients’ electronic medical record (EMR) to identify lung cancer screening candidates at a large and diverse cancer center in Los Angeles. Methods: We examined 607 patients with non-small cell lung cancer (NSCLC) treated at the University of Southern California Norris Comprehensive Care Center or Los Angeles General Medical Center from 2009-2023. EMR data included age of diagnosis, sex, race/ethnicity, smoking history, and stage at diagnosis; for patients with unknown number of pack years (n=25) they counted as not qualified for screening. Identifiers investigated were International Classification of Disease, Tenth Revision (ICD-10) code for chronic obstructive pulmonary disease (COPD), prescription of inhaled steroids, and documented lung cancer history. Fisher’s exact test was used to compare proportion of qualified screeners among groups. Results: 35% (215/607) of patients would have qualified for lung cancer screening according to the USPSTF guidelines, including a greater proportion of males 52% (164/313) versus females 17% (51/293) (p&amp;lt;0.0001). In males, Non-Hispanic Whites (NHW) 59% (55/93) had a greater proportion that would qualify compared to Hispanics 41% (31/75) (p=0.0295). In females, NHW 34% (30/89) had the highest proportion of qualifiers while Asians 6% (6/104) and Hispanics 9% (6/66) had the lowest proportion of qualifiers (p&amp;lt;0.0001). 65% (215/332) of smokers qualified for screening; males had a higher percentage who qualified for screening versus females (164/234, 70% vs. 51/98, 52%, p=0.0024). By race, NHW male smokers had the highest proportion of qualifiers 77% (55/71) while Hispanic women had the lowest proportion of qualifiers 50% (6/12). 27% (89/332) of patients were found to have an ICD-10 code for COPD, including 18% (21/117) had an ICD-10 code for COPD who did not qualify. 19% (63/332) smokers received a prescription for inhaled steroids, including 15% (18/117) of them who didn’t qualify for screening. 12% had a family history of lung cancer (39/332), while 9% (10/117) of these patients didn’t qualify for screening. Conclusion: There were significant race and sex screening disparities among known NSCLC patients including under 10% of Asian and Hispanic females. There were about 10-15% known lung cancer patients who would not have qualified for screening found to have an ICD-10 code for COPD, an inhaled steroids prescription, or documented family history. These alternative identifiers may serve as identifiers for lung cancer screening candidates in the EMR to help address race and sex disparities in screening. Future directions should include simulation of these identifiers in larger patient datasets. Citation Format: Darin Poei, Aubree Mades, Iris Yao, Nick Ahn, Ajay Prasad, Jennifer Tsui, Jacob S Thomas, Jorge J Nieva, Robert Hsu. Race and sex disparities in lung cancer screening and evaluation of alternative identifiers in patients’ electronic medical record to better identify lung cancer screening candidates [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 A145.

Abstract A130: Examining breast cancer screening completion: Comparing patient self-report and electronic health record data at a Federally Qualified Health Center during the SARS-CoV-2 pandemic

Abstract Intro: There is evidence to suggest that preventive services, such as breast cancer screening, were impacted during the SARS-CoV-2 pandemic with interruption in screening mammogram services during March-July 2020. Federally Qualified Health Centers (FQHCs) are a critical health system to help better understand pandemic sequelae among diverse patient populations so teams can better prepare for a future pandemic. US Preventive Services Task Force (USPSTF) recommends average-risk patients aged 50-74 screen for breast cancer biyearly. Based on USPSTF recommendations in 2021, 76% of non-Hispanic White women and 74 % of Latina women were up-to-date on mammography screening. Our study, RESTORE, focuses on understanding patient barriers and facilitators to completing breast cancer screening at one large urban FQHC during the pandemic. Here, we compare FQHC patient self-reported completion of breast cancer screening to documented breast cancer screening found in the electric health record (EHR). Methods: Patients (n=20) were interviewed between July 2023 and February 2024 about their healthcare utilization, breast cancer screening (including medical site), and health literacy throughout the COVID period (2018-2022). When a screening date was documented in the EHR, interviewers mentioned the screening date to participants during the interview. Interviews were audio recorded and transcribed. A preliminary review of these interviews was conducted to collect self-reported breast cancer screening date and compare it to the date in the EHR. Results: Interviewees’ average age was 65.1 years; 70 % were Spanish-speaking; 60% were Latino, and 95% were female. Of the Spanish-speakers, 8 out of 14 patients self-reported completing a mammogram between 2018-2022, with 2 of 8 reporting having completed it with an onsite vendor. Only 3 of these 8 mammograms were captured in the EHR. Of these three, 2 patients were prompted with the EHR date during the interview: one patient agreed with the date while the other rejected the date. Among the English-speaking patients, 4 out of 6 patients self-reported completing a mammogram between years 2018-2022, all of these 4 self-reported dates were captured in the EHR. Of these 4 patients, all were prompted with the EHR date, 3 agreed to the date and one rejected the date, with 3 of 4 reporting having completed it with an onsite vendor.Conclusion: Throughout COVID, FQHC patients sought mammogram screening; however, gaps in data systems limited completeness of the health system’s mammogram EHR data. Time delays between patient experience and interview dates, complicated our understanding of patients’ COVID experiences. The inconsistency between self-reported dates and EHR dates also creates challenges educating and convincing patients to stay up-to-date on screenings based on recommended intervals. Missing EHR data could have also impacted staff not accurately following-up for mammograms or referrals. Additional work is needed to understand the opportunities to better integrate FQHC EHR with mammogram vendor data systems. Citation Format: Anne Escaron, Crystal Gomez, Jennifer Schneider, Jennifer Rivelli, Fabian Hidalgo, Gloria Coronado. Examining breast cancer screening completion: Comparing patient self-report and electronic health record data at a Federally Qualified Health Center during the SARS-CoV-2 pandemic [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 A130.

Abstract A126: Cancer screening trends in Louisiana’s sexual gender minority population

Abstract Cancer screenings in Louisiana (LA) have been consistently lower than the national average. Sexual and gender minorities (SGM) are more likely to be non-compliant with cancer screening guidelines and consistently do not meet cancer screening recommendations. This study compares compliance to cervical, breast, and colorectal cancer (CRC) screening guidelines over time between SGM and the non-SGM population in LA. Data were obtained from the LA 2014, 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS). The sample was divided into gay (including lesbian, gay, bisexual, or other sexual orientation other than straight) and straight. Three primary outcomes of interest were used to measure breast, cervical, and CRC cancer screening adherence based on the U.S. Preventive Services Task Force (USPSTF) screening recommendation at the time of each survey. Descriptive analysis and chi-square tests were conducted using sample weights. CRC had the lowest compliance rate in the entire population and across sexual orientation groups. Twenty-five percent of both populations had never received any CRC screening test. Comparatively, 3.6% of straight and 5.3% of gay populations had never received a mammogram while 6.6% of straight and 13.6% of the population had never received a pap smear. Significant improvements in compliance to breast, cervical, and CRC cancer screenings guidelines was observed among those who identified as straight over the survey years until 2020. Decreases in screening compliance were observed in this population from 2020 to 2022, likely due to the effects of the COVID pandemic. Screening compliance in those who identified as gay showed more variation over time in all three cancers. Screening compliance for CRC and cervical cancer were at its highest in 2016, declined to its lowest point in 2020, but increased in 2022. In 2016, there was a significant decline in breast cancer screening compliance in this population to the lowest ever observed in both groups. The initial increases in colorectal and cervical cancer screening observed from 2014 to 2016 among the gay population may be attributed to significant decreases in uninsured rates following the passage of the Affordable Care Act. Additionally, this population saw increased access to the private insurance market following the Obergefell decision and the Marriage Equality Act of 2015, which extended employer-sponsored coverage to same-sex couples. While breast cancer screenings declined from 2014-2016 in the gay population, there was a sharp increase from 2016 to 2018, which aligns with the 2016 expansion of Medicaid in Louisiana. Despite increases in access to insurance coverage, SGM individuals report being in fair or poor health and having negative experiences with healthcare providers at higher rates than their non-SGM counterparts. More research is needed to understand the healthcare landscape and experiences of SGM Louisianans. This will help to inform targeted interventions to increase screenings and improve cancer outcomes among this population. Citation Format: Bilikisu Elewonibi, Carleigh Baudoin, Ashely Fenton. Cancer screening trends in Louisiana’s sexual gender minority population [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 A126.

Abstract A117: Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data

Abstract Background: Despite cancer risk increasing with age, older women are less likely to be up-to- date with cervical cancer screening (CCS). CCS is recommended up-to 65 years, absent history of abnormal results. CCS rates are significantly lower among Hispanic women, despite higher cervical cancer incidence and mortality rates compared to non-Hispanic white women. In Texas, women older than 50 years have lower odds of timely pap testing. We examined CCS rates among older Hispanic women in Texas using data from the Behavioral Risk Factor Surveillance System. Methods: Our sample included 5,291 self-identified Hispanic women, ages 50-64. Outcome: receipt of pap smear within the last 3 years following the U.S. Preventive Services Task Force guidelines at the time each survey was conducted (years: 2018, 2020 and 2022). Descriptive analysis and chi-square tests were used to examine the proportion of women who reported receiving CCS within the recommended timeframe. Results: Only 63.75% (mean age = 56.4) reported getting a pap smear. Significant decreases were found among women who had a pap smear from 87.03% in 2018, 71.95% in 2020, and 43.24% in 2022 (p=0.00). Additional analyses will be conducted to test relationships with sociodemographic and healthcare variables. Conclusion: Older Hispanic women in Texas represented in this dataset are far from the 2030 Healthy People goal of 79% CCS. Decreases in CCS rates are possibly due to the COVID-19 pandemic impact on healthcare access. As the US population ages, research is needed to identify the potential systemic barriers this group is confronting to access preventive cancer care. Citation Format: Coralia Vázquez-Otero, Bilikisu Elewonibi, Adaobi Ankwe, Rhonda BeLue. Cervical cancer screening rates among older Hispanic women living in Texas: results using the BRFSS 2018, 2020, and 2022 survey data [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 A117.