Breast Cancer Screening Rates Research Articles

The association of Supplemental Nutrition Assistance Program (SNAP) benefits and breast, cervix, and colorectal cancer screening.

131 Background: Food insecurity is associated with healthcare access and utilization. The Supplemental Nutrition Assistance Program (SNAP) was created to reduce food insecurity for low-income households and hence may enhance health-seeking behaviors. However, it is unknown whether receipt of SNAP benefits is associated with rates of cancer screening. Our objective was to quantify the relationship of SNAP benefit receipt with cancer screening among low income individuals at high risk for food insecurity. Methods: The National Health Interview Survey (NHIS) provided by the Center for Disease Control and Prevention was utilized to identify high-risk adults ages 21 to 74 years eligible for screening for female cervix (21-65 years), colorectal (40-74 years), and/or female breast cancer (40-74 years). Data was included from the 2019 and 2021 surveys, with 2020 excluded due to limited cancer screening information. High-risk was defined as low or very low food security, household income < 125% federal poverty level, or having Medicaid insurance. Up to date cancer screening was defined as receipt of mammography within 2 years for breast cancer; receipt of a cervical cancer test within 5 years for cervix cancer; and receipt of sigmoidoscopy within the past 5 years, colonoscopy within 10 years, fecal immunohistochemistry (FIT) testing within 1 year, or sDNA-FIT testing within 3 years for colorectal cancer. We utilized logistic regression to compare screening rates by receipt of SNAP benefits and accounted for the complex survey design of the NHIS. Models were adjusted for covariates including age, race, ethnicity, sex (colorectal cancer screening only), income, education, marital status, insurance status, metropolitan residence status, survey year, food insecurity, and comorbidities. Results: A total of 6,111, 4,141, and 7,015 respondents were identified for cervix, breast, and colorectal cancer screening analyses, respectively. Among these respondents, 67%, 61%, and 60% were up to date on cervix, breast, and colorectal cancer screenings, respectively. Among this high-risk cohort, 43% of respondents reported receipt of SNAP benefits. Receipt of SNAP benefits was associated with increased odds of cervical cancer screening (OR = 1.18, 95% CI = 1.00 – 1.39, P=.046), which was limited to females ages 21-39 (OR = 1.36, 95% CI = 1.05 – 1.77, P=.022). Receipt of SNAP benefits was not associated with increased rates of breast or colorectal cancer screening. Conclusions: Receipt of SNAP benefits is associated with higher rates of cervical cancer screening among low-income females at high risk of food insecurity, particularly among young adults. These data suggest that efforts to address social determinants of health may improve access to care.

Disparities in Breast Cancer Screening Rates Among Adults With and Without Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities may face barriers in accessing healthcare, including cancer screening and detection services. We sought to assess the association of intellectual and developmental disabilities (IDD) with breast cancer screening rates. Data from 2018 to 2020 was used to identify screening-eligible individuals from Medicare Standard Analytic Files. Adults aged 65-79 years who did not have a previous diagnosis of breast cancer were included. Multivariable regression was used to analyze the differences in breast cancer screening rates among individuals with and without IDD. Among 9,383,349 Medicare beneficiaries, 11,265 (0.1%) individuals met the criteria for IDD. Of note, individuals with IDD were more likely to be non-Hispanic White (90.5% vs. 87.3%), have a Charlson Comorbidity Index score ≤ 2 (66.2% vs. 85.5%), and reside in a low social vulnerability index neighborhood (35.7% vs. 34.4%). IDD was associated with reduced odds of undergoing breast cancer screening (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.74-0.80; p < 0.001). Breast cancer screening rates in individuals with IDD were further influenced by social vulnerability and belonging to a racial/ethnicminority. Individuals with IDD may face additional barriers to breast cancer screening. The combination of IDD and social vulnerability placed patients at particularly high risk of not being screened for breast cancer.

Unique Breast Cancer Screening Disparities in a Safety-Net Health System

Breast cancer screening (BCS) disparities leave historically underserved groups more vulnerable to adverse outcomes. This study explores granular associations between BCS and patient sociodemographic factors in a large urban safety-net health system. A retrospective review among female patients ages 50-74 within an urban safety-net health system was conducted in 2019. All patients had a primary care visit in the past 2 years. Multiple patient health and sociodemographic characteristics were reviewed, as well as provider gender and specialty. Bivariate analyses and multivariable logistic regression were performed in 2022. The BCS rate among 11,962 women was 69.7%. Over half of patients were non-White (63.6%) and had public insurance (72.3%). Patients with limited English proficiency made up 44.3% of the cohort. Compared to their sociodemographic counterparts, patients with White race, English proficiency, and Medicare insurance had the lowest rates of BCS. Serious mental illness and substance use disorder were associated with lower odds of BCS. In multivariable analysis, when using White race and English speakers as a reference, most other races (Black, Hispanic, and Other) and languages (Spanish, Portuguese, and Other) had significantly higher odds of screening ranging from 8% to 63% higher, except Asian race and Haitian Creole language. Female (versus male) and internal medicine-trained providers were associated with higher screening odds. Multiple unique variables contribute to BCS disparities, influenced by patient and health system factors. Defining and understanding the interplay of these variables can guide policymaking and identify avenues to improve BCS for vulnerable or traditionally under-resourced populations.

Estimating uninsured and underinsured women eligible for Minnesota's Breast Cancer Screening Program.

Since its inception in 1991, the mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography. This program has demonstrated evidence showing that it has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.

Impact of age, race, and family history on COVID-19-related changes in breast cancer screening among the Boston mammography cohort study.

We studied women enrolled in the Boston Mammography Cohort Study to investigate whether subgroups defined by age, race, or family history of breast cancer experienced differences in the incidence of screening or diagnostic imaging rates during the COVID-19 lockdown and had slower rebound in the incidence of these rates during reopening. We compared the incidence of monthly breast cancer screening and diagnostic imaging rates over during the pre-COVID-19 (January 2019-February 2020), lockdown (March-May 2020), and reopening periods (June-December 2020), and tested for differences in the monthly incidence within the same period by age (< 50 vs ≥ 50), race (White vs non-White), and first-degree family history of breast cancer (yes vs no). Overall, we observed a decline in breast cancer screening and diagnostic imaging rates over the three time periods (pre-COVID-19, lockdown, and reopening). The monthly incidence of breast cancer screening rates for women age ≥ 50 was 5% higher (p = 0.005) in the pre-COVID-19 period (January 2019-February 2020) but was 19% lower in the reopening phase (June-December 2020) than that of women aged < 50 (p < 0.001). White participants had 36% higher monthly incidence of breast cancer diagnostic imaging rates than non-White participants (p = 0.018). The rebound in screening was lower in women age ≥ 50 and lower in non-White women for diagnostic imaging. Careful attention must be paid as the COVID-19 recovery continues to ensure equitable resumption of care.

Access to breast cancer screening among females in China: a focus report on screening rate and composition

Objective: To systematically integrate and analyze the breast cancer screening rates among females in China and to estimate the composition of different screening service types. Methods: Based on core literature, relevant official websites, projects/survey reports, and information on breast cancer screening rates of Chinese females were extracted and analyzed, and the screening rates for 40-69 years old and 35-64 years old were standardized and compared using 2010 China's population structure. The literature review method was used to retrieve the journal literature related to the composition of breast cancer screening services types (organized screening, physical examination and opportunistic screening). The number of detected literature and the median sample size of individual screening people of the three screening service types were analyzed, and used them as weights to estimate the composition of screening service types. Results: A total of 6 related national surveys on breast cancer screening rate were identified, including 2 from the National Health Service Surveys (broader definition of "breast screening" in 2013, 2018) and 4 from the chronic disease monitoring system of China CDC (the exact definition of "breast cancer screening" in 2010, 2013 and twice in 2015). The age-standardized analysis indicated that 1-year, 2-year and 3-year breast cancer screening rates in 2015 among females in China aged 40-69 years old were 16.9%, 20.2% and 21.4%, respectively. The ever-breast cancer-screened rates were 21.1% in 2013 and 23.5% in 2015 among females aged 40-69, and the corresponding rates were 23.3% and 25.7%, respectively, among females aged 35-64. When taking the literature published in 2015 for further literature review, 130 articles were included, in which the proportions of numbers of reports on organized screening, physical examination, and opportunistic screening were 71.0%, 23.7%, and 5.3%, respectively. Along with the extracted data on median sample sizes (shown in the main text) by breast cancer screening types, it was estimated that the individual service volume of corresponding screening types accounted for 88.0%, 11.2% and 0.8% among all the screened females in China in 2015. Conclusions: The breast cancer screening rates among females of appropriate age in China in 2015 are higher than those in 2013. The literature review analysis preliminarily suggested that the current breast cancer screening service type in China is mainly organized screening service.

Breast Cancer Knowledge and Mammography Use Among Asian American Women Aged 40 and Older: Using the Transtheoretical Model Approach.

Mammography screening rates remain low among Asian American women (AAW). The aims of our study were to: (a) assess breast cancer knowledge and mammography screening behaviors, and (b) identify the factors related to the transtheoretical model (TTM) stages of change in relation to mammography utilization among AAW aged 40 and older. Using a cross-sectional design, a convenience sample of 714 AAW completed a structured questionnaire in 2021. Participants demonstrated a moderate level of knowledge regarding breast cancer and mammography. Only 34.2% of the participants reported obtaining regular mammograms. The ordinal logistic regression indicated that age, birthplace, health perception, breast biopsy history, breast cancer knowledge, self-efficacy, and perceived barriers were correlated with TTM stages of change. Our results highlight the need for implementing effective interventions aimed at increasing knowledge and screening rates for breast cancer among AAW. Additional TTM studies with AAW are needed to determine the relationships among TTM constructs and develop theory-based programs to improve adherence to screening guidelines. Future research using a mixed-method design may provide opportunities to explore complex phenomena associated with breast cancer screening behaviors. Finally, further assessments of the Breast Cancer Knowledge Scale's psychometric properties are necessary to improve this instrument.

Associations between gynecologic clinician type and routine female sexual dysfunction screening.

Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates. This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations. Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates. Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer. FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures. There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates. This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases. Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women's health.

Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study.

Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.

Breast cancer and breast cancer screening use—beliefs and behaviours in a nationwide study in Malaysia

BackgroundMany upper-middle-income countries (UMICs), including Malaysia, continue to face low breast cancer (BC) screening rates and patients with delayed presentation of BC. This study investigated the role of beliefs about BC and use of screening (e.g. beliefs about whether or not screening reduced the possibility of dying from BC).MethodsA nationwide cross-sectional study was conducted in which a total of 813 women (aged ≥ 40 years old) were randomly selected and surveyed using the validated Awareness and Beliefs about Cancer (ABC) measure. The association between BC screening use, sociodemographic characteristics, and negative beliefs about BC screening were analysed using stepwise Poisson regressions.ResultsSeven out of ten Malaysian women believed that BC screening was necessary only when experiencing cancer symptoms. Women > 50 years and from households with more than one car or motorcycle were 1.6 times more likely to attend a mammogram or a clinical breast examination (mammogram: Prevalence Ratio (PR) = 1.60, 95% Confidence Interval (CI) = 1.19–2.14, Clinical Breast Examination (CBE): PR = 1.61, 95% CI = 1.29–1.99). About 23% of women expected to feel anxious about attending BC screening, leading them to avoid the procedure. Women who held negative beliefs about BC screening were 37% less likely to attend a mammogram (PR = 0.63, 95% CI = 0.42–0.94) and 24% less likely to seek a CBE (PR = 0.75, 95% CI = 0.60–0.95).ConclusionsPublic health strategies or behaviour interventions targeting negative beliefs about BC screening among Malaysian women may increase uptake and reduce late presentation and advanced-stage cancer. Insights from the study suggest that women under 50 years, in the lower income group without a car or motorcycle ownership, and of Malay or Indian ethnicity (compared to Chinese-Malay) are more likely to hold beliefs inhibiting BC screening.

Disparities in Breast Cancer Patients with Disabilities: Care Gaps, Accessibility, and Best Practices.

Significant disparities exist in detecting and treating breast cancer in women with disabilities, leading to cancer detection at advanced stages. This paper provides an overview of disparities for women with disabilities related to breast cancer screening and care, primarily focusing on significant mobility disabilities. Current care gaps include screening barriers related to accessibility and inequitable treatment options, with race/ethnicity, socioeconomic status, geographic location, and disability severity factors, mediating the disparities for this population. The reasons for these disparities are myriad and stem from both system-level deficiencies and individual-level provider bias. Although structural changes are warranted, individual healthcare providers must also be incorporated in the requisite change. Intersectionality is critical to disparities and inequities and should be central to any discussion of strategies for improving care for people with disabilities, many of whom have intersectional identities. Efforts to reduce screening rate disparities for breast cancer in women with significant mobility disabilities should start with improving accessibility through removing structural barriers, establishing comprehensive accessibility standards, and addressing healthcare provider bias. Future interventional studies are needed to implement and assess the value of programs to improve breast cancer screening rates in women with disabilities. Increasing the representation of women with disabilities in clinical trials may provide another avenue for reducing treatment disparities, as these trials often provide breakthrough treatment to women with cancer diagnosed at later stages. Ultimately, attention to the specific needs of patients with disabilities should be improved across the US to promote inclusive and effective cancer screening and treatment.

Impact of COVID-19 pandemic on breast cancer screening rates.

e18875 Background: The COVID-19 pandemic disrupted healthcare utilization in the US, with cancer screening being severely impacted. Little is known about the impact COVID-19 had nationally on breast cancer screening. The objective of this study was to examine the potential impact of the COVID-19 pandemic on breast cancer screening rates. Methods: Commercial Fully Insured and Medicare members of large national health plan meeting the Healthcare Effectiveness Data and Information Set (HEDIS) inclusion and exclusion criteria for the measurement years 2019, 2020 and 2021 were included in the study. Member demographic data were linked to race, zip code, socioeconomic status and region information. The pre-COVID period was defined as measurement year 2019, peak-COVID was defined as measurement year 2020 and post-peak-COVID-19 was defined as measurement year 2021. Screening incidence rate differences (IRD) and ratios (IRR) were calculated between the three time periods. Logistic regression was conducted to control for socio-demographic confounders. All analyses were conducted in Python; a p-value less than 0.05 was significant. Results: This study included 324,707, 400,740 and 532,879 members in pre-COVID, peak-COVID and post-peak-COVID periods, respectively. The screening IRD between pre-COVID and peak-COVID periods was -3.1% (95% confidence interval [CI] -3.5% to -2.7%; p &lt; 0.001) and the IRR was 0.961 (95% CI 0.956 – 0.966; p &lt; 0.001). Between the peak-COVID and post-peak-COVID periods, the IRD was -0.33% (95% CI -0.68% to 0.02%; p = 0.0675) and the IRR was 0.996 (95% CI 0.991-1.000; p = 0.0667). Comparing the pre-COVID to the post-peak-COVID period revealed a significant IRD (-3.4% [95% CI -3.8% to -3.0%]; p &lt; 0.0001) and IRR (0.956 [95%CI 0.952-0.961]; p &lt; 0.0001). Controlling for other confounders, the pre-COVID period was associated with significantly higher odds of receiving a screening mammogram compared to the peak-COVID period (odds ratio [OR]: 1.19 [95% CI 1.17-1.2], p &lt; 0.0001). Additionally, the post-peak-COVID period was associated with lower odds compared to the peak-COVID period (OR: 0.98 [95% CI 0.97-0.99], p &lt; 0.0001). Additional results are shown in Table 1. Conclusions: The COVID-19 pandemic resulted in significantly lower screening mammogram rates when compared to the pre-COVID period. Additionally, this decrease appeared to be durable into the post-peak-COVID period after controlling for other confounders for screening. Further follow up studies are warranted to characterize the potential rebound of screenings. [Table: see text]

Spatial and temporal epidemiological analysis on the mortality rate of female breast cancer in Suzhou, China: 2006–2020

Objective: The epidemiological trend and spatial distribution of female breast cancer mortality in Suzhou were analyzed, so as to provide a scientific basis for the prevention and treatment of breast cancer. Materials and Methods: The annual trend of female breast cancer mortality data from 2006 to 2020 years was analyzed. The spatial autocorrelation analysis was carried out by Moran’s I method of GeoDa software to explore its regional aggregation. Results: The average annual crude mortality rate (CR) of breast cancer in Suzhou was 8.54 per 100 000 from 2006 to 2020, while the age-standardized mortality rate (ASMR) was 7.38 per100 000. The annual change percentage (APC) of CR in the recent 15 years was 1.98% (1.30–2.66%), which was statistically significant (P&lt;0.001). The annual change trend of ASMR was decreased slightly (APC=−0.95%, P=0.04). Spatial analysis indicated that there was a certain clustering of breast cancer in Suzhou. The CR of female breast cancer in Suzhou showed an upward trend, but ASMR decreased slightly. Conclusion: Health promotion and education should be strengthened in the areas with a high incidence of female breast cancer death in Suzhou, and the participation rate of breast cancer screening should be further improved.

Breast Cancer Champions: a peer-to-peer education and mobile mammography program improving breast cancer screening rates for women of African heritage.

Nationally, women of African heritage die at higher rates from breast cancer than women of other races or ethnicities. We developed Breast Cancer Champions (BCC) a peer-to-peer education program, which recruited 12 women and deployed them into the community in August 2020 during the height of the COVID pandemic. BCC aims to improve breast cancer screening rates for women of African heritage through peer-to-peer education, which has proven successful for addressing cancer-related health disparities. BCC community experts, or "Champions," are peer-to-peer educators that conduct awareness and screening events in their communities. Champion's education activities were tracked by bi-weekly check-in calls, which recorded the activity type, location, and the number of participants for each event. We used spatial and statistical analyses to determine the efficacy of the program at increasing screening rates for women within the area of Champion activity versus women outside of their activity area. Over 15months, Champions conducted 245 in-person or online events to engage women in their community for screening. More women of African heritage were screened in areas Champions were active during the intervention compared to historical data comparing areas outside of the Champion activity in the prior 15months (X 2 = 3.0845, p = 0.079). BCC successes could be attributed to pivoting to online community building when in-person events were restricted and enabling Champions to design and conduct their own events, which increased outreach possibilities. We demonstrate improved screening outcomes associated with an updated peer-to-peer education program.

Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US

Women living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings. To assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness. This randomized clinical trial recruited and followed up women from rural Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3 study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022. The DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline. Receipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months. The sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P < .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P < .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group. In this randomized clinical trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US. ClinicalTrials.gov Identifier: NCT02795104.

Mediators of county‐level racial and economic privilege in cancer screening

Area-level social determinants of health (SDoH) impact access to cancer care and prevention. Little is known about the factors that underlie the impact of residential privilege on county-level cancer screening uptake. Population-based cross-sectional study examining county-level data was obtained from the Centers for Disease Control and Prevention's PLACES database, American Community Survey and the County Health Rankings and Roadmap database. The Index of Concentration of Extremes (ICE), a validated measure of racial and economic privilege, was examined relative to county-level rates of US Preventive Services Task Force (USPSTF) guideline-concordant screening for breast, cervical, and colorectal cancers. Generalized structural equation modeling was used to determine the indirect and direct effects of ICE on cancer screening uptake. Across 3142 counties, county-level cancer screening rates demonstrated geographical variation ranging from 54.0% to 81.8% for breast cancer screening, from 39.8% to 74.4% for colorectal cancer screening, and from 69.9% to 89.7% for cervical cancer screening. Of note, cancer screening rates for breast, colorectal, and cervical cancer all increased from lower (ICE-Q1) to higher (ICE-Q4) privileged areas (breast: Q1 = 71.0% vs. Q4 = 72.2%; colorectal: Q1 = 59.4% vs. Q4 = 65.0%; cervical: Q1 = 83.3% vs. Q4 = 85.2%; all p < 0.001). Mediation analysis revealed that the observed disparities between ICE and cancer screening uptake were explained by mediators such as poverty status, lack of health insurance or employment, urban-rural location and access to primary care physicians that accounted for 64% (95% confidence interval [CI]: 61%-67%), 85% (95% CI: 80%-89%), and 74% (95% CI: 71%-77%) of the effect on breast, colorectal, and cervical cancer screening, respectively. In this cross-sectional study, the association between racial and economic privilege on USPSTF-recommended cancer screening was complex and influenced by an interplay of sociodemographic, geographical, and structural factors. Understanding the underlying area-level SDoH that mediate disparities in cancer prevention strategies can help focus interventions to improve equity in cancer prevention.

Abstract P4-03-28: Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery

Abstract Background: Disparities in breast cancer outcomes are well documented, with a burgeoning body of literature shedding light on the influence of multiple factors. Much of the literature comes from the US, with the current situation in Canada less well understood. Canada’s universal health care system may mitigate some, but unlikely all differences. First generation immigrants compromise 21.9% of the Canadian population. Differences in breast cancer screening rates and stage at diagnosis have been demonstrated between immigrant and non-immigrant Canadian women. However, breast cancer outcomes in the Canadian immigrant population have not been well studied. Patient reported outcomes are one such set of outcomes and crucial in understanding the patient experience. The purpose of this study is to compare symptom burden and trajectories between immigrant and Canadian long-term resident women with breast cancer undergoing breast cancer surgery in Ontario. Methods: A population-level retrospective cohort-study using linked Ontario administrative databases was constructed. Women &amp;gt;18 years of age with newly diagnosed breast cancer between 2010-2016 undergoing surgery at a regional cancer center were included. Baseline variables including immigration status, age, stage, comorbidity and income quintile were collected. The proportion of patients reporting moderate/severe Edmonton Symptom Assessment System Scale (ESAS) scores for each of 9 individual symptom categories over time was collected. Multivariable logistic regression models using generalized estimating equations with exchangeable correlation structure to account for repeated measures were constructed to assess the probability of a moderate/severe score for each of the individual ESAS symptom categories. Results: The cohort included 14,056 women, of which 12,250 (87.2%) were categorized as long-term Canadian residents and 1,806 (12.8%) as immigrants. Immigrant women had a younger mean age of diagnosis (53 vs. 61 years), were more likely to reside in a lowest income quintile neighbourhood (22.2% vs 15.4%), were less likely to be on a primary care physician roster within the last 2 years (83.7% vs. 90.4%) and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p&amp;lt; 0.0001). The proportion of women reporting moderate/severe scores was significantly higher amongst immigrant women for 7/9 symptom categories (anxiety, depression, drowsiness, nausea, pain, shortness of breath and well-being) with the largest difference observed for depression (13.1% vs 10.8%, p&amp;lt; 0.0001) and pain (14.8% vs. 12.0%, p&amp;lt; 0.0001). Comparing symptom trajectories, differences between groups were most pronounced within the first 12 months, though for depression and pain, statistically significant differences also existed at 36 months. On multivariable regression analysis, immigration status was persistently associated with higher proportion of moderate/severe score for pain only (OR 1.12, 95% CI 1.02-1.23). Immigration status was associated with a protective effect for anxiety (OR 0.86, 95% CI 0.78-0.94), drowsiness (OR 0.81, 95% CI 0.73-0.89) and tiredness (OR 0.86, 95% CI 0.79-0.94). Conclusions: To our knowledge, this is the first study comparing symptom burden amongst immigrant and non-immigrant Canadian women with breast cancer at a population-level. Immigrant women undergoing breast cancer surgery were found to have a higher burden of symptoms across most categories, and for depression and pain this difference was found to persist even at 3-years. However, the higher burden of symptoms in many categories seemed to be explained by factors such as younger age and more advanced disease. Adjusting for other factors, immigrant women with breast cancer reported more pain, indicating a need for better symptom management in this population. Citation Format: Elena Parvez, Megan M. Chu, David Kirkwood, Aristithes Doumouras, Jessica Bogach. Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-28.

Breast Cancer Diagnosis and Survival among Patients Diagnosed by a Structured Community Based Screening Program Compared to Opportunistic Diagnosis: A Case Control Study.

Breast cancer is ranked as the most common type of cancer effecting women worldwide. Early detection is associated with improved morbidity and mortality, along with decreased recurrence rates, due to regular breast cancer screening recommendations advised for women over the age of 40. Women in the Kingdom of Saudi Arabia (KSA) typically present with advanced symptoms at later stages due to lower-than-average rates of breast cancer awareness and screening. A case-control study was conducted utilizing data collected over 20 years in the primary care clinics linked to at a tertiary hospital to demonstrate the role of structured breast cancer screening programs within well-established primary care setting. Results were compared with outcomes of cancer cases diagnosed in the community through opportunistic diagnosis. A total 292 patients included in the study had an overall mean survival time of 160 months, with a statistically significant higher survival time noted amongst the primary care group of 49 patients (p<0.01) by approximately 85 months. Clinical stages and clinical response rates between the two patient groups were found to be statistically significant (p<0.01), where 35 (73.3%) primary care patients were stage IIA and below, compared to 41 (30%) oncology patients. Patients who were diagnosed with breast cancer in the primary care group with well-established breast cancer screening programs were noted to present with breast cancer at earlier stages, have better prognosis and lower mortality as opposed to the oncology patient group. Our study highlights the need of structured breast cancer screening programs within well supported primary health services in Saudi Arabia and the region. Such programs were associated with improved survival outcomes and more favorable clinical responses. There is an urgent need to enable primary care services with the appropriate resources to significantly impact patient morbidity and mortality.

Impact of the COVID-19 pandemic on the breast cancer early diagnosis program in Brazil

During the COVID-19 pandemic, several screening exams were postponed, including mammograms. The aim of this study was to evaluate the impact of COVID-19 in mammographic screening in Brazil, considering 2015 to 2021. This was descriptive ecologic study based on the retrospective data of Brazil's mammographic screening program. A Brazilian national screening database (DATASUS – SISCAN (Cancer System Information)) was used as the data source, and the data in this database are publicly available for download and analysis. We report the number of screening rate from January 2015 to December 2021, using 2020 as reference year for COVID-19. From 2015 to 2021, 10,763,894 mammograms were performed and included in the analysis. Reductions of 39.6% and 13.3% were found in 2020 in 2021, respectively. During the pandemic's peak, the reduction was more pronounced, with maximum reductions of 82.4% in May 2020 and 34.8% in April 2021. There was an increase in the number of mammograms performed on high-risk patients from 11.2% in 2020 to 13.9% in 2021. This research demonstrated a decline in the breast cancer screening rate during the two years of the COVID-19 pandemic; this reduction will increase the burden of advanced breast cancer, potentially impacting morbidity and mortality related to this neoplasm.

Breast Cancer Screening and Perceptions of Harm among Young Adults in Japan: Results of a Cross-Sectional Online Survey.

Breast cancer is the most commonly diagnosed female cancer and the leading cause of cancer death. Early detection and treatment are important to reduce the number of deaths. Japan recommends mammography every two years for women over 40 years of age. However, in recent years, an increasing number of younger women have been undergoing breast cancer screening (BCS). To reduce the harms of BCS among young adults, our study extracted data from an online survey conducted in 2018 and applied χ2 tests and logistic analysis to identify the influencing factors regarding interest in undergoing BCS. The results of our analysis support the need for a reduction in the BCS rate through awareness regarding the harms of health screening among young people. In particular, for those who receive BCS through occupational screening, we believe that improving education on breast awareness, the accuracy of occupational screening, and breast self-examination methods could reduce the harms from BCS in younger age groups.