Cancer Control Program Research Articles

Co-designed study with the Traveller Community in Ireland to determine cancer awareness & attitudes

Abstract Background Irish Travellers are a distinct ethnic minority group (formal recognition March 2017). They experience higher mortality than the general population at all ages for all causes of death. Study Aim To determine cancer awareness and attitudes among the Traveller Community in Ireland, and to identify barriers/enablers to cancer risk reduction behaviours and early diagnosis of cancer. Methods A co-designed multi-method study was developed in collaboration with Pavee Point, a national NGO for Travellers, the National Social Inclusion Office (NSIO) and the National Cancer Control Programme (NCCP) including: 1. Consultation with Pavee Point and NSIO representatives to inform the study proposal and methodology. 2. Co-design of methodology for ethics applications and subsequent data collection plan including interview topic guides and the development of a culturally appropriate version of the NCCP’s 2022 National Survey on Cancer Awareness, adding questions on social determinants of health and screening participation. 3. Collaboration with 12 peer-led Primary Health Care for Travellers Projects (PHCTPs), to provide in-person training for Traveller Community Health Workers to undertake a cross-sectional survey of 380 adult Travellers. 4. Collaboration with PHCTPs to undertake 20 semi-structured interviews with Travellers. 5. Conduct of semi-structured interviews with healthcare professionals to explore perceptions of barriers/enablers for Travellers engaging with the health system. Lessons Learned Working closely and collaboratively with our study partners, we gained valuable insights which enabled effective and efficient data collection across 8 counties, while exceeding our survey target sample size. Implications for Research: Collaborative, trusting, and respectful relationships are critical for all studies, but particularly when working with minority groups. Conclusions The study findings will inform policy for improved cancer outcomes among Travellers in Ireland. Key messages • Formation of a collaborative and respectful relationship with the Traveller community has facilitated successful research. • Traveller Community Health Workers (peer researchers) were key to the success of data collection.

Uptake of cervical screening and acceptability of HPV self-sampling in Irish Traveller women

Abstract Introduction Irish Travellers are a minority ethnic group. The 2010 All-Ireland Traveller Health Study noted the life expectancy of Traveller women was 11 years shorter than women in the general population. Coverage of the CervicalCheck, the Irish cervical screening programme, is 78.7% overall, however, there is no recently published data on the attendance of Traveller women. This study sought to determine participation by eligible Traveller women in CervicalCheck and the acceptability of HPV self-sampling. Methodology A face-to-face cross-sectional survey, adapted from the National Cancer Control Programme’s 2022 National Survey on Cancer Awareness, was disseminated to Irish Travellers via Primary Health Care Travellers Project peer researchers, following ethical approval, May to December 2023. Results 451 Travellers participated; 286 (63.4%) were female. Of these, 178 (62.2%) were in the eligible age group for cervical screening. 134 (75.3%) advised they had received an invitation to screening; 121 (68% of all eligible; 90% of all receiving an invitation) advised they had attended at least once (regular attenders 88 (49.4%); 27 (15.2%) irregular attenders). Of all responders in the screening eligible age group, 36 (20.2%) reported HPV self-sampling as acceptable; 18 (50%) of these were non or irregular attenders at screening. Similar proportions of 25-45 year-olds (20.4%) and 46-65 year-olds (20%) reported HPV self-sampling as acceptable. Conclusions Irish Traveller women face barriers to accessing mainstream health services. Uptake of cervical screening overall is lower compared to the general population in this study; one issue may be unreliable postal service to Travellers and non-receipt of invitations. While the overall acceptability of HPV self-sampling was low at 20.2%, half of those who would self-sample did not attend or attended irregularly. HPV self-sampling has the potential to improve cervical screening rates among Traveller women. Key messages • Irish Traveller women’s uptake of cervical screening is lower than general population. • HPV self sampling has potential to improve cervical screening rates in Travellers.

The role of communication in the successful implementation of the Slovenian NCCP

Abstract Issue Cancer remains a significant global public health challenge, necessitating comprehensive strategies for effective control and management. Slovenian National Cancer Control Programme (NCCP) addresses this challenge by prioritizing proactive communication with various stakeholders engaged in cancer care planning, delivery and advocacy. The communication strategy within this programme plays a pivotal role in its successful implementation. Description of the problem Active engagement and collaboration among stakeholders is crucial for achieving the programme’s objectives. NCCP seeks to address this challenge through various communication activities by fostering dialogue, sharing best practices, and facilitating networking opportunities among oncology professionals throughout Slovenia. Additionally, it seeks to strengthen partnerships with sectors beyond health and prioritizes engagement with cancer patient advocacy groups. Results The programme has devised a long-term communication strategy, guiding annual communication plans to engage stakeholders and foster support for its objectives. Notable communication activities in the period 2022-2024 include: organizing annual meetings for different oncology stakeholders including cancer patient associations, hosting impactful professional events, conducting visits to regional cancer hospitals, distributing e-newsletters and managing a NCCP website. Initial outcomes indicate strengthened communication and collaboration among professionals and institutions in the field of oncology nationwide. Engagement with patient advocacy groups has facilitated discussions on topics important to patients. Lessons Effective communication with diverse stakeholders is crucial for comprehensive cancer control. Collaborating across sectors enhances the impact of cancer control initiatives. Enhanced networking fosters innovation and synergy among oncology professionals, positioning Slovenia for greater success in cancer control. Key messages • Slovenia’s NCCP prioritizes proactive communication, fostering collaboration among stakeholders. Annual events, newsletter, and partnerships strengthen awareness and drive comprehensive cancer control. • Long-term communication strategy of Slovenia’s NCCP drives stakeholder engagement, and supports strategic objectives. This proactive approach strengthens comprehensive cancer control efforts.

Five-year cancer survival rates in Monastir, Tunisia

Abstract Background Cancer is a major public health problem worldwide. To the best of our knowledge, there is no Tunisian population-based registry studies investigating cancer survival in Tunisia. The objectives of our study were to estimate the five-year cancer survival rates in the province of Monastir, Tunisia. Methods We performed a retrospective cohort study including patients originating from Monastir diagnosed with cancer between 2002 and 2014. Data were collected from the cancer register of the center. Patients were followed until December 2022. Results In total, 9318 cancer cases were identified of whom 5741 were included for the survival analysis. The 5-year cancer survival rate, all sites combined, was 46% (95% CI: 45-47.3). Among the 10 most frequent cancer sites in Monastir, cancers having the lowest 5-year survival rates were lung cancer in men (18.2% (95% CI: 15.6-20.7)) and stomach cancer in both sexes (32.1% (95% CI: 23.4-40.7) and 25.3% (95% CI: 16-34.5) in men and women respectively). The cancers with the highest 5-year survival rates among men were skin cancer (other than malignant melanoma) (64% (95% CI: 54.5-73.4)), prostate cancer (59.1% (95% CI:54.7-63.4)) and colon cancer (55.1% (95% CI: 47.7-62.4). In women, cervical cancer (70% (95% CI: 61.8-78.1), skin cancer (other than malignant melanoma) (66.2% (95% CI: 55.1-77.2) and breast cancer (63.8% (95% CI:58.8-67.7)) were those with the highest 5-year survival rates. Patients ≥ 65 years had the lowest 5-year survival rates for almost all cancer sites in both genders. Conclusions Our study has shown that cancer survival rates in Tunisia remain low compared to developed countries. The widespread implementation of cancer control programs including healthy lifestyle, education, screening and early detection are urgently needed. Key messages • The 5-year cancer survival rate, all sites combined, in Monastir was 46% (95% CI: 45-47.3). • Cancers with the lowest 5-year survival rates in Monastir were lung cancer in men and stomach cancer in both sexes.

Developing an Evidence-Based Primary Cancer Prevention Repository: insights from the PIECES project

Abstract Introduction Up to 40% of cancer cases could be avoided through effective primary prevention. However, cancer prevention tends to be fragmented across Europe, leading to geographical health differences. The dissemination and scale-up of effective primary cancer prevention interventions may address this. Although effective cancer prevention programs exist, finding them and their materials (especially regarding implementation) can be challenging. Repositories of evidence-based interventions provide insight into “what is out there” and can support dissemination within and across national borders. The PIECES project aims to develop and disseminate a repository of evidence-based primary cancer prevention programs adaptable to European contexts, with information to aid adaptation and implementation across countries. Methods The development of the PIECES repository has been informed by established repositories such as NCI’s Evidence-Based Cancer Control Programs. The project team developed a scoring sheet with a selection of items that could be included in the repository. All participants rated each item on relevance and applicability and provided comments and suggestions. A final framework, including a set of minimal requirement items, was agreed upon during three online consensus building meetings. Results We created a repository of evidence-based primary cancer prevention interventions targeting modifiable risk factors suitable for implementation in European healthcare settings. This 22-item repository provides information about an intervention’s logic model, implementation practices, and appraisal of published evidence of effectiveness. Conclusions This repository is innovative as it includes practical information and tools to facilitate implementation. While initially built to serve the PIECES project, the repository is designed to be a valuable tool for European policymakers, researchers, and implementers. Lessons learned from this process will inform future developers. Key messages • A comprehensive cancer prevention intervention repository avoids “reinventing the wheel” and allows for more efficient use of existing interventions by building upon the best available evidence. • The ongoing efforts of the PIECES project represent a significant contribution to reduce cancer prevention disparities and to facilitate the adoption of evidence-based interventions in Europe.

Using the innovative tool to prepare a quality national cancer control programme

Abstract Issue National cancer control programmes (NCCPs) are key documents in European Member States (MSs) used for the management of cancer policy. While some countries still have not prepared their NCCPs, there are several others, whose NCCP is not of high quality or not implemented. Description of the problem There is frequently a lack of knowledge in countries on how to prepare a quality NCCP or how to improve the existing one. Our objectives were: 1. To provide help in the preparation of an NCCPs and in cancer control to EU MSs 2. To enhance the availability of all the documents needed and provide best practices from other MSs. The development of an innovative tool was therefore the main objective of iPAAC Joint Action (JA). Streamlining of all NCCP-related documents prepared by the three JAs in cancer policy (EPAAC, CanCon, iPAAC) was central to the deliverables. Results The solution lied in the preparation of the interactive innovative tool called Roadmap on the Implementation and Sustainability of Cancer Control Actions (Roadmap). It was developed in a joint effort and collaboration between EU MSs and the European Commission. It is available online and can be used by all countries, including countries that are not part of EU, and who aim at preparing a high quality NCCP. The extensive content of the tool covers primary prevention, health promotion, screening, diagnosis, treatment, and health care, as well as a number of sub-areas with important contents, and over a hundred one-pagers, which include national and regional experiences. Among the latter, the European Guide for Quality NCCPs with instructions how to prepare a quality NCCP is presented as one pager. Lessons As the result of over 10 years of joint work in cancer control at EU level MSs have now both, the opportunity to learn from each other and the opportunity to access all key information they need for controlling cancer, including the instructions on the preparation of the key document, their NCCP. Key messages • Using the Roadmap countries have access to instructions and guidance for the preparation of a quality NCCP. • The Roadmap enables the access to all key documents for the management of cancer control in one place to all countries.

Assessment of sun protection factors in the Irish adult population following the SunSmart Campaign 2023.

SunSmart is the National Cancer Control Programme's annual skin cancer prevention awareness campaign. This study aimed to assess sun protection attitudes following the 2023 campaign, and compare findings to 2022. An online survey was conducted in September 2023, a repeat of the 2022 survey. Data were collated and analysed in Excel. In 2023, 48% (n=480) adults reported being sunburnt that summer. Younger adults were more likely than older adults to report sunburn (62% v 28% p<0.001). In assessing the "SunSmart 5s": 94% rated sunscreen, 88% rated shade, 84% rated hats, 71% rated long sleeves, and 70% rated sunglasses as important. Older adults were more likely than younger adults to rate each factor as important. A higher proportion reported each factor as important compared to 2022. Awareness of the campaign increased, 32% having heard of SunSmart, compared to 21% in 2022 (p<0.001). Awareness was higher in older adults (39% v 21% p<0.001), and in those who reported no sunburn (34% v 30% p=0.023). Awareness of SunSmart and perceived importance of the sun protection factors have improved since 2022, with perceived importance of the "SunSmart 5s" reasonably high. Reaching younger adults and improving their sun protection behaviours remain areas for progress.

Prevalence and distribution of human papillomavirus genotypes in women with abnormal cervical cytology in Ethiopia: a systematic review and meta-analysis.

Cervical cancer is the 4th most common cancer in women globally. Determining the prevalence of the high-risk human papillomavirus (HR-HPV) and low-risk (LR-HPV) genotypes and the distribution in abnormal cervical cytology will be essential in a future population-based cervical cancer prevention program. Primary studies with women with abnormal cervical cytology were systematically searched for in Medline, CINHAL, Google Scholar, African Journal Online, and the University of Antwerp repository from 19-30 May 2023. A weighted inverse-variance random effects model was used. Variations across the studies were checked using a forest plot, I2 statistics, and Egger's test. Group analysis was performed for evidence of heterogeneity. The pooled prevalence of human papillomavirus (HPV) genotypes with abnormal cervical cytology of a precancerous cervical lesion was 38.74% (95% CI: 27.56-49.93). The leading pooled prevalence estimates by subgroup analysis were 18% (95% CI: 13-26), 14% (95% CI: 111-16), and 66% (51-79) for women with retroviral infection (RVI), DNA genotyping with amplification, and central parts of Ethiopia respectively. There were 25 HPV variants identified by genotyping techniques with the five most prevalent HPV genotypes being HPV-16 and HPV-18 coexisting at 54%; HPV-16 alone at 29%; HPV-51 at 16%; HPV-52 at 13%; and HPV-31 and HPV-33 each contributing approximately 12%. The pooled prevalence of HPV genotypes was higher than in other countries. HPV-51, HPV-52, HPV-31, and HPV-33 are the most prevalent genotypes. Hence, the nonavalent vaccine type would be the one that includes all the most prevalent HPV genotypes, but HPV-51in Ethiopia. Additional data on similar DNA test techniques for comparisons with precancerous lesions and invasive cancer are needed. Cervical cancer prevention and control programs in Ethiopia should be aligned with the most prevalent genotypes. https://www.crd.york.ac.uk/prospero/, identifier CRD42023428955.

An Exploration of the Utility and Impacts of Implementation Science Strategies by Cancer Registries for Healthcare Improvement: A Systematic Review

Background: Cancer data registries are central elements of cancer control programs providing critical insights in measures of performance in cancer healthcare delivery. Evidence to practice gaps in cancer care remain substantial. Implementation science (IS) strategies target gaps between generated research evidence and guideline concordance in delivered healthcare. We performed a systematic review of the utilisation and effectiveness of IS strategies reported by cancer registries. Methods: A research protocol and literature search were performed seeking studies incorporating implementation strategies utilised by cancer registries for quality improvement. Searches were undertaken in MEDLINE, Embase, CENTRAL, and the grey literature for randomised trials and observational studies. The "Knowledge to Action" (K2A) framework was used to explore implementation gaps in care delivery. Results: Screening identified 1496 studies, 37 studies identified by title and abstract review, and 9 included for full text review. Studies originated from the United Kingdom, the United States, the Netherlands, and Australia reporting on lung, breast, colo-rectal, and cancer clusters. Registry jurisdictions included 7 national, 4 state, and 4 local registries. Knowledge gap analysis consistently identified monitoring and evaluation of data outcomes in accord with registry primary purpose although limited exploration of the utilisation, translation and re-application of this data. Studies lacked description of strategies describing sustainability of generated knowledge, identification of barriers, knowledge adaptation to local contexts, and the selection, adaptation and implementation of interventions for improvement. Conclusion: Available studies provide limited literature evidence of the effective utilisation of IS strategies reported by cancer registries for healthcare improvement. A substantial opportunity presents to study the engagement of IS in cancer registry data use to close the evidence practice gap and facilitate data driven improvement in cancer healthcare.

Establishing a cancer registry and baseline data for Nyandarua County, Kenya: A step towards establishing a central cancer registry

Cancer is a major global public health issue, causing a significant number of premature deaths worldwide. In 2020, the World Health Organization reported that more than 19 million individuals were diagnosed with cancer, and over 10 million lost their lives to the disease. Predictions indicate that cancer-related deaths will exceed 30 million by 2030, with around 75 % occurring in low- and middle-income countries (LMICs) like Kenya. Various factors contribute to this concerning trend, including aging populations, a high prevalence of cancer risk factors, socioeconomic disparities resulting in limited healthcare access, and deficiencies in healthcare systems within LMICs. This study focused on Nyandarua County, Kenya, which lacks a dedicated cancer registry. Without comprehensive incidence data, the county faces challenges in developing targeted programs for cancer prevention, management, and control. The main objective of this investigation was to establish a cancer registry specific to Nyandarua County, capable of continuously gathering accurate cancer data, patient treatment follow-ups and disease outcomes. A demographic survey was conducted to determine the frequency of all-cause and specific cancers among patients who attended selected health facilities between 2013 and 2020. Data were collected from existing hospital records in three main hospitals in the county. A total of 1373 cases were recorded, with 54.9 % of patients being female. North Kinangop Catholic Hospital accounted for the largest number of patients (62 %), followed by JM Kariuki County Memorial Hospital (35 %), while Engineer Hospital contributed the remaining 3 %. The top five cancer sites observed in Nyandarua County were esophagus (16.8 %), cervix uteri (13.4 %), stomach (10.6 %), breast (8.8 %), and prostate (8.6 %). Our findings provide valuable insights into the prevalence and distribution of different types of cancer in the region. With the establishment of this cancer registry, Nyandarua County is now among the pioneering counties in Kenya. It is crucial for the county government to undertake the responsibility of continuously updating the registry to draw inferences regarding cancer prevalence in the region to enhance patients follow up and survival.

The role of primary care practitioners in cancer control in South Africa: a systems-based case study

Aim Cancer care has largely been the domain of oncology specialists. With increased awareness of the importance of primary care in the context of universal health coverage, there has been a shift to explore the role of primary care in comprehensive cancer management. This includes health promotion, screening, diagnosing, referral to oncology services, and longitudinal care that includes co-ordination of care, survivorship, and palliative care. This paper focuses on the role of primary care practitioners in health promotion, early detection and care co-ordination. Nurses and doctors who work in primary care are included as primary care practitioners. Methods Using a patient vignette narrative tool, the triad of patient empowerment in the form of enhanced health literacy, clinical competence, and system effectiveness, are discussed as the basis for early cancer detection. A complex intervention to improve primary-level cancer care and the implications thereof for the important role of care co-ordination undertaken by primary care practitioners, is also presented. Findings For effective patient assessment, primary care practitioners must be trained in screening and diagnostic techniques as part of their clinical competencies as generalists. These competencies include risk identification, counselling skills, expert clinical examination, interpretation of basic x-rays, minor surgical skills, interpreting blood tests, and point-of-care ultrasound. Against a backdrop of ongoing budget constraints, consumables and equipment needed for diagnosis should be readily available and referral pathways for patients and specimens should be clearly defined and resourced. Conclusions Primary care practitioners in community-based facilities are well-placed to engage with the psychosociocultural dimensions of care. The SA health system places primary care at the point of closest contact with communities. Efficient care pathways are needed by primary care practitioners to adopt the role of care co-ordinator when patients with suspected or confirmed cancer enter these pathways. When considered alongside the overburdened primary care patient-load and the ever-increasing mix of co-morbidities, the complexity of primary care is appreciated. Understanding the complexities of primary care in the context of cancer control is an important component of a holistic cancer control programme.

The regional cancer spectrum in Uganda: a population-based cancer survey by sub-regions (2017-2020).

Accurate estimation of the burden of cancer in developing countries is a major public health concern for cancer prevention and control because of the limited coverage of population-based cancer registries (PBCRs). The cancer registration coverage status of Uganda was 11.90% and was not uniformly distributed in all regions of Uganda. This population-based survey was conducted to assess the burden of cancer in all the sub-regions of Uganda by site, sex and age group to accurately determine the cancer profile of Uganda by sub-region for a tailored intervention to mitigate cancer risk factors and burden. This study used existing administrative units of Uganda from which 55 districts emerged, forming 10 sub-regions as satellite population-based cancer registry study sites. Data on newly diagnosed cancer cases were retrospectively collected for the period 2017-2020 using a cancer notification form, entered into CanReg5 Software, exported to spreadsheets and univariate analysis was performed to determine the cancer spectrum, their proportions and crude rates by site, sex, age group and geographical location. A total of 25,576 cancer cases were registered, up to 14,322 (56%) were in females and, male cancers were 11,254 (44%). The top five female cancers in all the sub-regions included cervical cancer (43%, n = 6,190), breast (22%, n = 3,200), esophagus (5.6%, n = 800), ovary (5.2%, n = 746), Kaposi Sarcoma (KS) (4.7%, n = 666) and other less common cancers (18.5%, n = 2,720). In males, the top five cancers included prostate cancer 25.1 % (n = 2,820), esophagus 15.1% (n = 1,704), KS 12.4% (n = 1,395), liver 8.8% (n = 989) and stomach 4.8% (n = 539), with other less common male cancers accounting for 33.8% (n = 3,807).In all the sub-regions of Uganda, cancers of the esophagus, liver and KS are common in both males and females, but the number of males with these cancers is twice that of their female counterparts. In Rwenzori, Kigezi and Bugishu sub-Regions, there seems to be an increased risk of developing other skin cancers in females, while stomach cancers have been reported in both males and females. Most of the other sub-regions register emerging cases of only ovarian cancer in females. In children, the top three cancers included lymphoma, 33.9% (n = 653); soft tissue sarcomas, 20.8% (n = 400); malignant bone tumors, 15.8% (n = 305); myeloid-type leukemia, 13.8% (n = 265); and the other less common childhood cancers combined, 15.7% (n = 303). The proportion of childhood cancers is higher in the male child compared to the female at a ratio of 1.3:1. The sub-regional cancer spectrum in Uganda ranges from cervical cancer to breast, esophageal, ovarian and KS in females. Male cancers include prostate, esophageal, KS, liver and stomach cancers. Although the cancer profile is similar in most sub-regions of Uganda, except Ankole subregions with mountainous topography (Rwenzori, Kigezi, Bugisu), there has been significant variation in cancer profile, especially for males, where Non-Hodgkins Lymphomas is one of the cancers reported for Uganda by PBCRs in Gulu, and Kampala has been replaced by stomach cancers as one of the common male cancers in the sub-regions. These findings emphasize the need for the establishment and support of additional regional PBCRs and periodic population-based cancer surveys to accurately determine the burden of cancer, inform the establishment of regional cancer centers and guide national and sub-national cancer control programs in Uganda. Cancer surveillance systems using PBCRs should be part of the national cancer control program. Periodic population-based cancer surveys should also be conducted as part of Uganda's demographic and health surveys in areas without PBCRs to inform the country comprehensively and accurately on the cancer burden to design robust cancer mitigation measures.

Abstract B099: Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program

Abstract Purpose The Scaling What Works (SWW) program aimed to build the capacity of National Comprehensive Cancer Control Program (NCCCP) recipients to scale three CDC-identified cancer control projects through training, mentorship, and technical assistance (TA). The SWW program held a Symposium to provide in-person training on adapting, implementing, evaluating, sustaining, and scaling the three projects. We recruited 100% of US-Affiliated Pacific Island (USAPI) NCCCP programs (n=6), who made up approximately 26% of all programs that attended the Symposium (n=23). The USAPI jurisdictions face high cancer burden due, in part, to the United States nuclear legacy, the effects of climate change, limited medical infrastructure, and lack of culturally competent, centralized care across the almost 4,000 miles that the USAPI spans. Through the SWW program, USAPI recipients are supported in their ongoing efforts to mitigate cancer disparities affecting their communities. MethodsWe applied community-based participatory research methods and health equity principles to ensure the SWW program was relevant and responsive to the USAPI recipients’ contexts and needs. We created a SWW subcommittee to learn about and advocate for the specific needs of the USAPI. The committee spoke with ten clinicians and researchers with experience working in the USAPI, across four informal meetings, to understand the unique cancer prevention and control context of each USAPI jurisdiction. The committee reviewed USAPI cancer plans and extracted data related to SWW activities, including cancer prevention priorities, community partners, demographic characteristics, and healthcare infrastructure. Data were added to a matrix, coded, and summarized by subcommittee team members to develop a USAPI fact sheet. We shared the fact sheet with SWW Symposium facilitators and mentors to provide them with the necessary information to support the USAPI programs. Findings We identified components critical to providing effective training and TA that will support USAPI-led work to address disparities in cancer prevention and control. These components include 1) acknowledging the current and historical power dynamics that establish the USAPI cancer prevention and control program space, 2) adjusting generalized training content to each jurisdiction’s unique context and cancer prevention goals, 3) adapting communication strategies to USAPI programs’ preferences and time zones, 4) facilitating networking opportunities both between NCCCP USAPI jurisdictions and across all NCCCP recipients to build a SWW community of practice, and 5) establishing a sustained, bidirectional partnership between USAPI program leaders and the SWW team to collaborate on future cancer prevention and control projects and to provide training and TA, as needed. ConclusionsThe lessons learned from SWW regarding health equity and capacity-building can inform the efforts of researchers, evaluators, and training and TA providers working with USAPI jurisdictions, states, and territories engaged in cancer prevention and control work. Citation Format: Amy L. Tran, Mary Wangen, Renée M. Ferrari, Jingle Xu, Alison T. Brenner, Stephanie B. Wheeler, Rebecca J. Lee, Elizabeth A. Rohan, Angela R. Moore, Shixiu Wang, Alyssa LaMonica, Mary Puckett, Amy L. Thompson, CK Smith, Katie Jones, Malesa Pereira, Rogelio Robles-Morales, Lori A. Crane, Courtney N. Petagna, Thuy T. Vu, Betsy C Risendal, Rachel Hirschey. Addressing cancer disparities in the United States-Affiliated Pacific Island jurisdictions: Insights from the Scaling What Works program [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 B099.

Abstract A154: Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities

Abstract Introduction: Breast cancer is the leading cause of cancer-related deaths among women, with rural communities having the highest rates of breast cancer mortality. Despite this burden, many women begin mammography later than recommended and the mammography screening rate remains low, with a previously reported declining trend, particularly among rural women compared to urban women. This study seeks to identify barriers to breast cancer screening and examine strategies to overcome these barriers in rural Missouri. Methods: In partnership with the Missouri Cancer Consortium and the Missouri Comprehensive Cancer Control Programs, we conducted key informant interviews with mammography health providers at health centers in each of ten counties with the highest breast cancer mortality and lowest screening mammography rates in Missouri. Semi-structured interviews included questions about seeking and delivering breast cancer screening as well as provider experiences with patient navigation, mobile mammography, and the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Data were analyzed using a deductive-inductive thematic approach in NVivo 14. Results: We conducted 14 interviews with health providers across 12 health sites. The majority of these sites used patient navigation (67%), mobile mammography (80%), and the CDC NBCCEDP (67%) as strategies to improve access to breast healthcare. Health providers frequently mentioned “no-shows” as a major challenge to providing breast healthcare, along with limited transportation, cost, fear, and competing work priorities as the major barriers faced by patients in seeking breast healthcare. Patient navigation and mobile mammography were beneficial in bringing breast healthcare closer to the community, while the CDC NBCCEDP covered screening and follow-up costs. The main facilitating factors to implementing these strategies were having dedicated staff and funding for patient navigation, and existing partnerships with other health institutions for mobile mammography. However, health providers identified several implementing challenges for the strategies. This included limited staff capacity and difficulty contacting or following up patients to schedule appointments for patient navigation and mobile mammography. For the CDC NBCCEDP, the challenges included difficulty identifying eligible patients and extensive paperwork in the enrollment process. Providers recommended increasing staff capacity to support patient navigation, using digital technology in identifying and enrolling women for the CDC NBCCEDP, and integrating mobile mammography with the CDC NBCCEDP to improve implementation efficiency. Discussion: The integration of multiple component strategies within breast healthcare may address the multi-level barriers women face in accessing breast cancer screening. This study contributes to the identification of organizational supports and informs development of policies needed to enhance the adoption and implementation of strategies that support the effective delivery of breast healthcare. Citation Format: Thembekile Shato, Carmen Vardeman, Sarah J. Chavez, Ashley C. Holmes, Joann Lee, Xarria Lewis, Katie Manga, Misty Phillips, Keisha Windham, Bettina F. Drake. Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities [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 A154.

Abstract A124: An examination of trust in biomedical research among the Witness Project’s community health workers

Abstract The Witness Project® (NWP) was established in 1991 and has maintained its status as one of NCI’s Evidence Based Cancer Control Program (EBCCP) for decades. NWP is a self-sustaining, culturally competent, grass roots level community-based intervention program that uses breast and cervical cancer survivors known as Witness Role Models and Community Health Workers (CHW). With many locations in unserved communities throughout the United States, NWP provides relevant cancer related education and navigates minority residents through successful completions of cancer related screenings. Health disparities are a longstanding problem due in part to underrepresentations of historically underserved populations in research. Increasing minority and underserved individuals’ participation in research has great disparity mitigating potential. A team of newly trained Black and Hispanic NWP CHW (n=25) will be created as part of a larger multiphase preliminary pilot study designed to increase diverse individuals’ participations in research within Roswell Park’s catchment area. Design, Measures, Setting, and Participants. The primary objective of this cross-sectional study is to assess Black and Hispanic CHW’s trust in biomedical research. Secondary objectives are to explore the feasibility and acceptability of 1) NWP CHW training, and 2) an informal educational intervention about the importance of minority representations in research and it potential to mitigate health disparities. CMWs will complete the Perceptions of Research Trustworthiness (PoRT) scale to evaluate their trust and distrust in biomedical research before and after viewing the informal educational intervention. Preliminary Results and Planned Analyses At the time of abstract submission nineteen CMWs have completed their NWP and CITI training and PoRT assessments. Fifteen CHWs were Black (78.9%) and four Hispanic (21.1%). When all 25 CMWs are trained we will calculate overall and individual item Trust and Distrust subscale scores. Regarding feasibility and acceptability of the CHW training and the informal education intervention, semi structured interviews will provide qualitative feedback and independent samples t-test will be used to compare pre-and post-informal education intervention PoRT scores. Citation Format: Julia Devonish, Martin Mahoney, Elizabeth Bouchard, Cassy Dauphin, Abshiro Ali, Veronica Meadows, Jomary Colon, Dee Johnson. An examination of trust in biomedical research among the Witness Project’s community health workers [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 A124.

Practitioner perspectives on equitable implementation of evidence-based interventions for cancer prevention and control.

Longstanding inequities in cancer prevention and control require novel approaches to improve evidence-based intervention implementation. Exploring and elevating the perspectives of cancer prevention and control practitioners working to advance health equity and equitably implement evidence-based interventions is an important yet underutilized step among researchers working in this space. The purpose of this study was to explore practitioners' perspectives of how health equity is defined and integrated into their work, challenges of advancing health equity for implementation in local settings, and associated strategies. We conducted virtual key informant interviews and focus groups with 16 US practitioners (e.g. clinicians, health administrators, public health professionals) in 2021-2022. Interviews and focus groups were audio recorded and transcribed. Data were coded using inductive content analysis and summarized into themes. Four major themes emerged: (i) how health equity is conceptualized as a process and outcome; (ii) need to shift equity mindsets; (iii) importance of community partnerships; (iv) organizational policies and strategies for fostering equity in implementation. Respondents noted the need for research and medical communities to learn about the importance and benefits of allowing communities to shape implementation to advance equity in the delivery of evidence-based interventions and outcomes. Additionally, respondents emphasized that institutional leaders should initiate changes regarding equitable implementation at the organizational- and system-levels. Respondents endorsed the need to address equity issues related to the implementation of cancer prevention and control programs, practices, and policies. Many findings can be applied beyond cancer prevention and control to support equitable implementation and outcomes more generally.

Cancer Care in Resource-Limited Countries: Jordan as an Example.

Jordan, a lower- to middle-income country, is relatively small, but with rapidly growing population and a challenged economy. Cancer is a growing health care problem and currently ranked second, after cardiovascular diseases, as a cause of death. Jordan's national cancer registry continues to suffer from problems mostly related to long lag time in reporting, absence of outcome data, and accurate staging. The number of new patients with cancer diagnosed in Jordan is increasing at an expected, none disturbing rate, fueled by population growth, improving life expectancy, changing population structure that hosts more older population, high rate of obesity, smoking, and lack of adequate exercise. However, age-standardized rate for cancer incidence is significantly lower than Western societies, yet, mortality rate is higher. Despite efforts, cancer is still diagnosed at more advanced stages and at younger age. The Jordan breast cancer program represents a great example of opportunistic screening that led to significant downstaging of breast cancer. Efforts to evaluate the feasibility of screening programs for colorectal and lung cancers are underway. Tremendous efforts resulted in the execution of the largest clinical cancer genetics program in the region that helps identify patients and at-risk relatives for hereditary cancers. Low-resourced countries, including Jordan, will not be able to keep up with the rapidly increasing cost of cancer care. A better access to clinical trials and moving cancer care to ambulatory settings should offset some of this cost. A cancer control program that addresses all issues of cancer care from screening and early detection, through active cost-effective treatment that assures wider access to palliative care, hospice, and survivorship programs under an expanded universal health coverage, is an urgent national health priority.

Perspectives of non-physician partners on barriers and facilitators to AYA cancer care in Latin America.

Cancer is the fourth leading cause of death in adolescents and young adults (AYA) worldwide. Although successful treatment of cancer in AYA has increased in recent years in most of the world, this is not true for many low- and middle-income countries (LMIC) where over 80% of all AYA live. This study investigated the needs of AYA with cancer in parts of Latin America (LATAM) through the perspectives of non-physician health care providers and partners. Semi-structured interviews (in Spanish) were conducted with non-physician partners from Mexico, Peru, Central America, and the Caribbean over Zoom. Participants were recruited through previously identified local physicians and international non-physician professionals working in these countries. Transcripts were coded and key themes identified until thematic saturation was reached (Atlas.ti). Thirty participants representing eight countries were interviewed, providing 1202 min of transcript data. Data were organized into barriers, facilitators, and strategies to improve the delivery of health care for AYA with cancer in LATAM at the patient- (e.g., financial barriers, continued schooling), parent- (e.g., limited medical literacy, advocacy), and hospital-level (e.g., structural barriers, increasing funding). There are many similarities in the barriers and facilitators to AYA care between LATAM and high-income countries (HIC); however, some characteristics are more unique to LATAM, for example, strict age restrictions for pediatric care and abandonment of therapy. As LATAM countries continue to build cancer control programs, there is an opportunity to consider our identified barriers, facilitators, and strategies to address the unique needs of AYA with cancer.

S02-3: Slovenian Approach to Enhance Physical Activity Among Vulnerable Populations

Abstract Purpose These policy documents foster physical activity and sports that empowers every individual, regardless of their age, health status, or background, to lead healthier, more active lives. Methodology was based on desk research, analysis and synthesis of Slovenian policy documents. Policy Description In Slovenia, policy documents significantly influence the landscape of physical activity and sports, reflecting the nation's commitment to a healthier and more active society for all, including vulnerable populations. The National Sports Program (2014-2023), outlines a strategic direction for sports development, with a focus on enhancing participation and excellence in sports. This program affects a wide range of populations, including children, adults, individuals with disabilities, and those with chronic diseases. The National Nutrition and Physical Activity Programme (2015-2025), places strong emphasis on the importance of nutrition and physical activity in improving public health and overall well-being. The impact of this program extends to all citizens, with a particular emphasis on children, pregnant women, adults, and individuals with chronic diseases. 3. The Strategy for the Health of Children and Adolescents (2012; still ongoing), prioritizes the well-being of young generations by considering their environment, including opportunities for physical activity. This strategy primarily targets children and adolescents, addressing concerns related to obesity, health inequalities, and chronic non-communicable diseases. The Action Programme for Persons with Disabilities (2022-2030), promotes accessibility to sports and physical activities for individuals with disabilities. Strategic plan for the Development of the Cycling Network with Action Plan (Acceptance Predicted in 2024), aims to enhance active transportation options and promote physical activity, including people with disabilities. The National Diabetes Prevention and Care Development Programme (2020-2030), have a significant impact on raising awareness about health and physical activity, primarily targets residents with diabetes and those at risk. 7. The National Cancer Control Programme (2022-2026), focusing on prevention and care. Conclusion The impact of these policies extends to children, adults, and vulnerable populations, including those with disabilities and chronic non-communicable diseases. These policies create a framework that empowers all citizens, regardless of age or health status, to lead healthier, more active lives.

Prevalence and genotype distribution of potential high-risk and high-risk human papillomavirus among women attending selected reproductive health clinics in lake victoria basin-kenya: a cross-sectional study

BackgroundPersistent human papillomavirus (HPV) infection is considered the primary etiological factor for invasive cervical cancer. Understanding the epidemiology of circulating potential high-risk (HR) and HR HPV strains is essential in updating epidemiological knowledge and recommendations on genotype-specific vaccination development. This study determined the prevalence and factors associated with Potential HR/HR HPV among women attending selected reproductive health clinics in Lake Victoria Basin.MethodsA cross-sectional facility-based survey made up of 434 women aged 16–68 years was carried out in two selected facilities. Structured questionnaires were administered to collect participant clinical and social characteristics. Cervical specimens were collected and HPV genotyping was carried out using RIATOL HPV genotyping qPCR assay. Descriptive statistics followed by logistic binary regression was done using R version 4.3.2.ResultsThe overall prevalence of potential HR/HR HPV among women attending the selected reproductive health clinics was reported at 36.5% (158/434). Specifically, in the rural setting, Gobei Health Center, the prevalence was 41.4% (41/99) while in the urban setting-JOOTRH, it was 34.6% (117/335). The most prevalent potential HR/HR HPV are 52, 67, 16, 31, 39, 45, and 31 among women. Age was the main factor associated with HPV infection with women between the age of 30–39 having the highest risk (AOR = 0.3, CI:0.2–0.7, p < 0.001).ConclusionIn both rural and urban regions, potential HR/HR HPV infection among women attending reproductive health clinics at the selected facilities remains common. The study identifies the need for effective implementation and clinical follow-up process of cervical cancer control program in the LVB.