Recommended Screening Age Research Articles

Abstract 1772: Cancer prevalence and screening among US Asian adults by nativity

Abstract Background: While heart disease is the leading cause of death in the general United States (US) population, the number one cause of death among US Asian adults is cancer. The cancer burden in the US is higher than that in Asia. However as Asians migrate to the US, acculturation may increase their risk of acquiring cancers. We examine the prevalence of selected cancers and recommended screening behaviors among Asian Americans by US nativity. Methods: We analyzed combined data from the 2010 and 2013 National Health Interview Survey (NHIS) to examine the prevalence of selected cancers and adherence to the US Preventive Services Task Force (USPSTF) recommended screening behaviors by US nativity among more than 4,000 non-Hispanic Asian adults aged 18 and over. Asian adults include persons who identified their race as “Asian,” “Asian Indian,” “Chinese,” “Filipino,” “Korean,” “Japanese,” “Vietnamese,” or other detailed Asian responses, identified no other non-Asian races, and now reside in the US. Nativity was determined by place of birth located within or outside the US or its territories. Survey data were weighted to produce national estimates that are representative of the civilian noninstitutionalized US adult population. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Results: While the overall prevalence of cancer among Asian adults (3.1%) was not significantly different from that of their non-Hispanic white adult peers (3.4%), US born Asian adults were approximately 1.7 times more likely to have had a cancer diagnosis compared with Asian adults born outside the US. Nativity was not significantly related to cancer diagnosis for non-Hispanic white adults. There was no significant difference by US nativity in the prevalence of colorectal cancer among Asian adults aged 50-75 or breast cancer among Asian women aged 40-75. However, US born Asian women aged 21-65 without a hysterectomy were more than 5 times as likely to have a diagnosis of cervical cancer as their peers who were born outside the US. There was no significant difference in adherence to the USPSTF recommended mammography or colorectal screening among US born Asian adults within the recommended screening age groups compared with those born outside the US. However, US born Asian women were more likely to adhere to the USPSTF recommended screening for cervical cancer compared with those born outside the US (79.0% vs. 70.0%). Conclusion: The higher prevalence of cancer among US Asian adults compared with those not born in the US appears to be driven by differences in cervical cancer prevalence. Although higher than their peers born outside the US, adherence to USPSTF recommended cervical screening among US born Asian women aged 21-65 remains lower than the Healthy People 2020 baseline of 84.5%. Citation Format: Tainya C. Clarke. Cancer prevalence and screening among US Asian adults by nativity. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1772.

Bioimpedence to Assess Breast Density as a Risk Factor for Breast Cancer in Adult Women and Adolescent Girls.

Although high mammographic density is one of the strongest predictors of breast cancer risk, X-ray based mammography cannot be performed before the recommended screening age, especially not in adolescents and young women. Therefore, new techniques for breast density measurement are of interest. In this pilot study in Guam and Hawaii, we evaluated a radiation-free, bioimpedance device called Electrical Breast DensitometerTM (EBD; senoSENSE Medical Systems, Inc., Ontario, Canada) for measuring breast density in 95 women aged 31-82 years and 41 girls aged 8-18 years. Percent density (PD) was estimated in the women's most recent mammogram using a computer-assisted method. Correlation coefficients and linear regression were applied for statistical analysis. In adult women, mean EBD and PD values of the left and right breasts were 230±52 and 226±50 Ω and 23.7±15.1 and 24.2±15.2%, respectively. The EBD measurements were inversely correlated with PD (rSpearman=-0.52, p<0.0001); the correlation was stronger in Caucasians (rSpearman=-0.70, p<0.0001) than Asians (rSpearman=-0.54, p<0.01) and Native Hawaiian/Chamorro/Pacific Islanders (rSpearman=-0.34, p=0.06). Using 4 categories of PD (<10, 10-25, 26-50, 51-75%), the respective mean EBD values were 256±32, 249±41, 202±46, and 178±43 Ω (p<0.0001). In girls, the mean EBD values in the left and right breast were 148±40 and 155±54 Ω; EBD values decreased from Tanner stages 1 to 4 (204±14, 154±79, 136±43, and 119±16 Ω for stages 1-4, respectively) but were higher at Tanner stage 5 (165±30 Ω). With further development, this bioimpedance method may allow for investigations of breast development among adolescent, as well as assessment of breast cancer risk early in life and in populations without access to mammography.

Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.

Although colorectal cancer (CRC) screening guidelines recommend initiating screening at age 50 years, the percentage of cancer cases in younger patients is increasing. To the authors' knowledge, the national treatment patterns and outcomes of these patients are largely unknown. The current study was a population-based, retrospective cohort study of the nationally representative Surveillance, Epidemiology, and End Results registry for patients diagnosed with CRC from 1998 through 2011. Patients were categorized as being younger or older than the recommended screening age. Differences with regard to stage of disease at diagnosis, patterns of therapy, and disease-specific survival were compared between age groups using multinomial regression, multiple regression, Cox proportional hazards regression, and Weibull survival analysis. Of 258,024 patients with CRC, 37,847 (15%) were aged <50 years. Young patients were more likely to present with regional (relative risk ratio, 1.3; P<.001) or distant (relative risk ratio, 1.5; P<.001) disease. Patients with CRC with distant metastasis in the younger age group were more likely to receive surgical therapy for their primary tumor (adjusted probability: 72% vs 63%; P<.001), and radiotherapy also was more likely in younger patients with CRC (adjusted probability: 53% vs 48%; P<.001). Patients younger than the recommended screening age had better overall disease-specific survival (hazards ratio, 0.77; P<.001), despite a larger percentage of these individuals presenting with advanced disease. Patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease. These findings suggest the need for improved risk assessment and screening decisions for younger adults.

Ischemic Stroke in Children and Young Adults with Sickle Cell Disease (SCD) in the Post-STOP Era

Background: The Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) established routine transcranial Doppler ultrasound (TCD) screening with indefinite chronic red cell transfusions (CRCT) for children with abnormal TCD as standard of care. To identify children at high-risk of stroke, annual TCD screening is recommended from ages 2 to 16 years, with more frequent monitoring if the result is not normal. A reduction in stroke incidence in children with SCD has been reported in several clinical series and analyses utilizing large hospital databases when comparing rates before and after the publication of the STOP study in 1998. We sought to determine the rate of first ischemic stroke in a multicenter cohort of children who had previously participated in the STOP and/or STOP 2 trials and to determine whether these strokes were screening or treatment failures.Subjects and Methods: Between 1995 and 2005, STOP and STOP 2 (STOP/2) were conducted at 26 sites in the US and Canada. These studies included 3,835 children, ages 2 to 16 y with SCD type SS or S-beta-0-thalassemia. Participation in STOP/2 ranged from a single screening TCD to randomization. STOP 2 also had an observational arm for children on CRCT for abnormal TCD whose TCD had not reverted to normal. The Post-STOP study was designed to follow-up the outcomes of children who participated in one or both trials. 19 of the 26 original study sites participated in Post-STOP, contributing a total of 3,539 (92%) of the STOP/2 subjects. After exit from STOP/2, these children received TCD screening and treatment according to local practices. Data abstractors visited each clinical site and obtained retrospective data from STOP/2 study exit to 2012-2014 (depending on site) including follow-up TCD and brain imaging results, clinical information, and laboratory results. Two vascular neurologists, blinded to STOP/2 status and prior TCD and neuroimaging results, reviewed source records to confirm all ischemic strokes, defined as a symptomatic cerebral infarction; discordant opinions were resolved through discussion. For the first Post-STOP ischemic stroke, prior TCD result and treatment history subsequently were analyzed.Results: Of the 3,539 subjects, follow-up data were available for 2,850 (81%). Twelve children who had a stroke during STOP or STOP2 were excluded from these analyses resulting in data on 2,838 subjects. The mean age at the start of Post-STOP was 10.5 y and mean duration of follow-up after exiting STOP/2 was 9.1 y. A total of 69 first ischemic strokes occurred in the Post-STOP observation period (incidence 0.27 per 100 pt years). The mean age at time of stroke was 14.4±6.2 (median 13.8, range 3.5-28.9) y. Twenty-five of the 69 patients (36%) had documented abnormal TCD (STOP/2 or Post-STOP) prior to the stroke; 15 (60%) were receiving CRCT and 9 (36%) were not (treatment data not available for 1 subject). Among the 44 subjects without documented abnormal TCD, 29 (66%) had not had TCD re-screen in the Post-STOP period prior to the event; 7 of these 29 (24%) were 16 y or older at the start of Post-STOP, which is beyond the recommended screening age. Four of the 44 (9%) patients had inadequate TCD in Post-STOP (1 to 10.7 y prior to event). Six (14%) had normal TCD more than a year before the event (1.2 - 4 y); all but one of these children were younger than 16 y at the time of that TCD. Only 5 (11%) had a documented normal TCD less than 1 year prior to the event.Conclusions: In the Post-STOP era, the rate of first ischemic stroke was substantially lower than that reported in the Cooperative Study of Sickle Cell Disease, prior to implementation of TCD screening. Many (39%) of the Post-STOP ischemic strokes were associated with a failure to re-screen according to current guidelines, while only 11% occurred in children who had had recent low-risk TCD. Among those known to be at high risk prior to stroke, treatment refusal or inadequate treatment may have contributed. While TCD screening and treatment are effective at reducing ischemic stroke in clinical practice, significant gaps in screening and treatment, even at sites experienced in the STOP protocol, remain to be addressed. Closing these gaps should provide yet further reduction of ischemic stroke in SCD. DisclosuresNo relevant conflicts of interest to declare.

Cervical cancer screening in young and elderly women of the Xingu Indigenous Park: evaluation of the recommended screening age group in Brazil.

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population.Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011.Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth.Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age.

Further Evidence to Lower the Recommended Screening Age for Colorectal Cancer

Purpose: Most national colorectal cancer (CRC) screening programs begin at the age of 50 years. This is despite evidence that CRC presents at an increasingly young age. We studied CRC screening in a regional Australian population group from 40 years of age utilising GPs as the point of contact for obtaining a screening kit. Methods: A regional Australian population-based study in Wagga Wagga, New South Wales, Australia encouraged people aged 40 upwards to visit their GP for an immunochemical faecal occult kit (FIT/ocsensor, Eiken Chemical, Tokyo, Japan. Sensitivity 50 ng/1 mL). The study utilised the infrastructure of Murrumbidgee Medicare Local and local gastroenterologists/surgeons for colonoscopies. Data was collected over a five-month period in 2012. Results: 1,409 kits were processed. A total of 203 were positive (14.4%). Overall, there have been 14 cancers, 59 adenomas (including multiple adenomas), and 13 hyperplastic polyps; 51 positive tests were received from the 40-49 year old age group. In this group, two cancers (both women) and eight adenomas, four being advanced (>1 cm) and four multiple, including advanced. Three hyperplastic polyps were identified and 37 colonoscopies were normal. Consequently, 20% of the results detected a significant lesion. In the 50-59 year old age group, there were five cancers and seven adenomas. In the 60-69 year old age group, there were five cancers and 15 adenomas. Two cancers were identified in people aged greater than 70 years. Conclusion: The main limitation of this study is the small sample size of 1,409 subjects. This highlights the continuing issue of people choosing not to be screened, despite a media campaign and utilising GPs to educate and promote screening. A positivity rate of 14.4% is high; this rate may be accounted for by the site of the study in regional Australia and warrants explanation. The 40-49 year old age group contained 20% with a significant lesion, including two Duke's A cancers. This is a concern if we continue to promote the age of 50 as being the starting point for a CRC screening. Adenoma removal at an early age is the key to prevention.

Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Breast Cancer Screening Perceptions among American Indian Women under Age 40

Breast cancer mortality rates are the second leading cause of cancer death in American Indian (AI) women. AI breast cancer screening rates have been decreasing, and AI women have some of the lowest screening rates compared to other racial/ethnic groups. Our research team investigated breast cancer and breast cancer screening education prior to recommended age for screening. It is imperative to examine the perspectives of young AI women toward breast cancer screening to better understand screening perceptions among AI women. Following a community-based participatory research approach, we conducted five focus groups and four interviews with AI women aged 25-39 (N = 48) in Kansas and Missouri. Nine themes emerged from the focus groups and relate to topics such as the following: knowledge of breast cancer and breast cancer screening, barriers to screening and treatment, suggestions to improve access, and perceptions and use of health-care systems. Specifically, we found that AI women lacked knowledge of details about screenings and their risks for getting breast cancer, cost was cited as a primary barrier to screening, additional education was needed (particularly materials that were AI focused), breast health was generally not discussed with others, and more instruction was requested for techniques used to identify bodily changes or abnormalities. Understanding attitudes of AI women not of recommended screening age may provide an insight into low screening rates among AI women. Furthermore, the results may inform outreach strategies to improve current and future screening rates.

Cumulative incidence of cancer after solid organ transplantation.

Solid organ transplantation recipients have elevated cancer incidence. Estimates of absolute cancer risk after transplantation can inform prevention and screening. The Transplant Cancer Match Study links the US transplantation registry with 14 state/regional cancer registries. The authors used nonparametric competing risk methods to estimate the cumulative incidence of cancer after transplantation for 2 periods (1987-1999 and 2000-2008). For recipients from 2000 to 2008, the 5-year cumulative incidence, stratified by organ, sex, and age at transplantation, was estimated for 6 preventable or screen-detectable cancers. For comparison, the 5-year cumulative incidence was calculated for the same cancers in the general population at representative ages using Surveillance, Epidemiology, and End Results data. Among 164,156 recipients, 8520 incident cancers were identified. The absolute cancer risk was slightly higher for recipients during the period from 2000 to 2008 than during the period from 1987 to 1999 (5-year cumulative incidence: 4.4% vs. 4.2%; P = .006); this difference arose from the decreasing risk of competing events (5-year cumulative incidence of death, graft failure, or retransplantation: 26.6% vs. 31.9%; P < .001). From 2000 to 2008, the 5-year cumulative incidence of non-Hodgkin lymphoma was highest at extremes of age, especially in thoracic organ recipients (ages 0-34 years: range, 1.74%-3.28%; aged >50 years; range, 0.36%-2.22%). For recipients aged >50 years, the 5-year cumulative incidence was higher for colorectal cancer (range, 0.33%-1.94%) than for the general population at the recommended screening age (aged 50 years: range, 0.25%-0.33%). For recipients aged >50 years, the 5-year cumulative incidence was high for lung cancer among thoracic organ recipients (range, 1.16%-3.87%) and for kidney cancer among kidney recipients (range, 0.53%-0.84%). The 5-year cumulative incidence for prostate cancer and breast cancer was similar or lower in transplantation recipients than at the recommended ages of screening in the general population. Subgroups of transplantation recipients have a high absolute risk of some cancers and may benefit from targeted prevention or screening.

Validität der Empfehlungen zur Sekundärprävention von Dickdarmkrebs

Prevention programmes should only be recommended if they achieve what they promise to achieve. Therefore, we checked the variation and validity of recommendations for screening for colorectal cancer of nine organisations. We analysed the information concerning recommended screening age, guaiac faecal occult blood test (gFOBT), faecal immunological test (FIT), faecal DNA test, sigmoidoscopy, colonoscopy, double-contrast examination/double-contrast barium enema, and virtual colonoscopy/CT colonography in the following three steps: 1) we gathered the references quoted by the nine organisations; 2) references were categorised according to mortality, incidence and sensitivity/specificity; 3) the validity of references that reported reduced mortality attributed to screening were evaluated. Evidence of occult faecal blood was the only screening method recommended by all nine organisations. Colonoscopy was recommended by seven organisations. Fifteen of the 33 references used endpoints other than mortality to justify screening. One publication was a meta-analysis. Eleven of 17 publications evaluated the gFOBT, three evaluated sigmoidoscopy, one FIT, one coloscopy, and one general diagnosis of the intestine. On average, two of nine validity criteria were completely fulfilled, five only partially, and two were not fulfilled. In two publications, none of the validity criteria were completely met. Analysis of screening for colorectal cancer revealed that nine organisations had different goals and different recommendations. Scrupulous and thorough evaluation of the scientific studies in relation to mortality, upon which these recommendations are based, revealed numerous shortcomings and therefore could not sufficiently substantiate the international recommendations for screening for colorectal cancer. It would be useful to establish a consensus about which data have to be collected to provide a reliable basis for health-care decisions.

Cervical cancer screening programme in Limpopo province: January 2007 to December 2010

AbstractObjective: South Africa launched a cervical screening policy in 2001 and aimed to screen 70% of women aged 30 years and older by the year 2010. The current study describes the performance of the cervical cancer screening programme that was implemented in the Limpopo province between 2007 and 2010.Design: A retrospective descriptive analysis of data on cervical smears that were collected and evaluated by the National Health Laboratory Services in the Limpopo province from 2007 to 2010.Outcome measures: Screening coverage, smear adequacy, appropriate age for screening and prevalence of premalignancy were calculated.Results: Overall, 202 251 cervical smears were submitted in the Limpopo province between 2007 and 2010. The number of smears increased from 39 029 in 2007 to 63 512 in 2010. Of the 202 251 women screened, 130 911 (72.7%) were within the recommended screening age (30 years and older). Annual screening coverage rates ranged from 2.9-4.2% of the population of women aged 30 years and older. T...

Colorectal cancer screening using protected microRNAs.

Colorectal cancer is one of the most frequent malignant tumors (1) with the fourth highest incidence and second highest mortality of any cancer in the United States (2). As a result of aggressive screening and education, the last 30 years has shown a significant decrease in US mortality rates. However, in countries where the screening and education have not been as aggressive, and in US patients whose age is below the recommended screening age, the rates are increasing (3). It is therefore important to aggressively investigate all novel, basic science avenues and/or discoveries in the context of colorectal cancer with the ultimate goal of its eradication. Screening for colorectal cancer involves guaiac-based, fecal occult blood and fecal immunochemical occult blood testing. More recently, the approach to assay stool and bodily fluids from colorectal cancer patients for biomarkers representative of the disease such as APC, p53 and K-Ras have been exploited with limited success. Fecal DNA-based testing, performed on cells sloughed or shed from tumors into the stool has revealed aberrant hypermethylation of CpG islands (4). Though many of these assays have been exploited in the detection of colorectal cancer for the last three decades they are limited due to low specificity and sensitivity. It is therefore important that assays be developed that provide diagnostic information and help in the therapeutic decision for patients suffering with colorectal cancer. Extracellular membrane vesicles ranging in diameter of 30-150 nm and originating from various cellular origins have been increasingly recognized for their participation in a variety of both normal and pathological cellular processes (5). Regardless of their cell type of origin these membrane bound vesicles or exosomes provide a protected and controlled internal microenvironment outside the cell for metabolic objectives of the host cell to be carried out at a distance from the host cell (6). As was demonstrated by Koga et al., (7) in this issue of Journal of Gastrointestinal Oncology, these exosomes provide a protective membrane that in the harsh fecal environment increases the stability of their contents. Exosomes are also believed to be instrumental in cell-cell and cell-extracellular communication (8). Moreover, while knowledge of exosome biogenesis and physiological relevance remains limited, accumulating evidence suggests that their bioactivity may be clinically applicable in cancer therapeutics (9). The content of the exosome and the subsequent biological function depends on the cell of origin. Recent studies have shown that besides protein, RNA and miRNAs are also actively secreted in exosomes that protect them from degradation by RNases (10),(11). These proteins and RNAs provide a profile and possible understanding of the cellular proteome and transcriptome at the time of collection. In addition, serial samples identified over time will allow for a robust, simple and noninvasive molecular means to study the evolving genetic changes relative to tumor progression (11) as well as provide a marker of prognosis and therapeutic response using serum, plasma, urine or as is the case of Koga et al., feces. miRNA are small noncoding transcripts that have been identified as cellular molecules with important diagnostic, prognostic and therapeutic implications (12),(13). Though their biology is still not entirely understood, each miRNA may control hundreds of mRNA targets, the results of which are to regulate gene expression. Specifically, miRNAs have been shown to reduce the stability of mRNAs involved in inflammation, cell cycle regulation, stress responses, differentiation, apoptosis and invasion (14). Additionally, miRNAs having both tumor-suppression and oncogenic functions have been shown to be dysregulated in many types of cancer (15). Exosomes isolated from feces using immunomagnetic beads proved to have stable miRNA which remained so even when exogenous RNase was added for an additional ninety minutes. Specifically, the colorectal cancer important miRNA, miR-21, which has an enhanced expression in colorectal cancer compared to normal colorectal mucosa, has been shown to be unstable when investigated directly from stool samples. However, when investigation of stool-purified exosomes, miR-21 was protected from the harsh conditions of the feces (7). Research on tumor-exosomes and their roles as messengers within the tumor microenvironment is an exciting field that continues to stimulate and enhance the field of cancer biology with new ideas, questions and hypotheses. Investigating these hypotheses requires tools to affect the exosome biology including their content and secretion. The study by Koga et al., has important implications for colorectal cancer screening. Koga et al. (7), demonstrate that exosomes prevent the RNase-dependent degradation of miRNAs. Indeed, fecal miRNA-based testing, performed on tumor-exosomes sloughed or shed into the stool, will allow molecular-based diagnosis that in time may also aid in therapy decisions and disease response surveillance leading to better management of colorectal cancer.

Locally advanced breast cancers are more likely to present as Interval Cancers: results from the I-SPY 1 TRIAL (CALGB 150007/150012, ACRIN 6657, InterSPORE Trial)

Interval cancers (ICs), defined as cancers detected between regular screening mammograms, have been shown to be of higher grade, larger size, and associated with lower survival, compared with screen-detected cancers (SDCs) and comprise 17% of cancers from population-based screening programs. We sought to determine the frequency of ICs in a study of locally advanced breast cancers, the I-SPY 1 TRIAL. Screening was defined as having a mammogram with 2 years, and the proportion of ICs at 1 and 2 years was calculated for screened patients. Differences in clinical characteristics for ICs versus SDCs and screened versus non-screened cancers were assessed. For the 219 evaluable women, mean tumor size was 6.8 cm. Overall, 80% of women were over 40 and eligible for screening; however, only 31% were getting screened. Among women screened, 85% were ICs, with 68% diagnosed within 1 year of a previously normal mammogram. ICs were of higher grade (49% vs. 10%) than SDCs. Among non-screened women, 28% (43/152) were younger than the recommended screening age of 40. Of the entire cohort, 12% of cancers were mammographically occult (MO); the frequency of MO cancers did not differ between screened (11%) and non-screened (15%). ICs were common in the I-SPY 1 TRIAL suggesting the potential need for new approaches beyond traditional screening to reduce mortality in women who present with larger palpable cancers.

Is It Time to Lower the Recommended Screening Age for Colorectal Cancer?

Overall, colorectal cancer (CRC) incidence in the US has decreased over the last 30 years, yet it has increased in patients younger than 50. Cancers in this population are more aggressive and advanced at diagnosis. Our goal was to determine if screening should begin at a younger age. To accomplish this, we analyzed the rates of change in CRC incidence, and compared the incidence with that of cervical cancer (CC), which is screened earlier. Locations of CRC were compared to determine the appropriate screening method. Incidence statistics were obtained from the Cancer Query System of the SEER database. Data were obtained from 1987 to 2006 in age groups of 5-year increments from 0 to 4 years old to 85+ years old for incidences of colon, rectal, and overall CRC. Combined data from 2002 to 2006 were queried to determine the locations of tumors and the overall incidence of CRC and CC at different ages. Across age groups 20 to 49, CRC incidence was higher in 2006 than in 1987. The most significant increase was from age 40 to 44, where CRC increased from a low of 10.7 per 100,000 in 1988 to 17.9 per 100,000 in 2006 (67%). Colon and rectal cancer increased 56% and 94%, respectively. People older than 50 had decreasing incidences. Approximately 30% of cancers in patients aged 35 to 49 occurred proximal to the splenic flexure. The incidence of CRC cancer equaled and subsequently surpassed CC in the 40 to 44 age group. The most significant increase in CRC has occurred in patients ages 40 to 44. Patients over 50 continued to see a decline. Many of these cancers would be missed with sigmoidoscopy. Consideration should be given for age-based colonoscopic screening beginning at age 40, an age at which the incidence mirrors other accepted screened cancers.

Abstract B112: Relationship of colorectal cancer awareness and knowledge with colorectal cancer screening: results of a population-based study

Abstract Purpose: Participation in colorectal cancer (CRC) screening lags behind screening for other types of cancer despite the ability to prevent the development of CRC and down-stage disease. The purpose was to describe the association of CRC awareness and knowledge with CRC screening. Methods: Trained interviewers from a professional survey firm conducted computer-assisted, random digit dialed telephone interviews, with landline and cell phone numbers, using a 144-item instrument developed via literature review, expert panel review, and pretesting. South Carolina residents aged 45-75 years were contacted. For this paper, analysis was restricted to respondents aged 50-75 (n=1,302) who fall in the recommended screening age range and answered knowledge, awareness, and screening items. Data were analyzed with SAS and STATA. Odds ratios were adjusted for race and gender. Results: Respondents (n=1,503) were mostly female (63%), EA (77%), had at least some college education (59%), had household income of less than $49,999 (48%), married or lived with a partner (62%), had health insurance (91%), and unemployed/not working (57.1%). Mean age was 60.3 years (SD=8.6). A majority of respondents had heard of CRC (91%). Of those who had heard of CRC, the majority had heard of CRC screening (96%). More than half of respondents (69%) could name any of the CRC screening tests. The most common CRC screening test named was colonoscopy (90%). Respondents who had heard of a CRC had greater odds of having had any CRC screening test (aOR=1.71; CI: 1.06-2.76; p&amp;lt;0.028) and colonoscopy (aOR=1.59; CI: 1.03-2.45; p&amp;lt;0.034) than those who had not heard. Respondents who could correctly name at least one CRC screening test had greater odds of having had any CRC screening test (aOR=3.74; CI: 2.76-5.08; p&amp;lt;0.001) and colonoscopy (aOR=3.69; CI: 2.83-4.82; p&amp;lt;0.001) than those who could not name a test. A CRC awareness index score (range 0-4) was created by assigning a +1 to each of four awareness items. A one-unit increase in the awareness score significantly increased respondents being more likely to have had CRC screening test (aOR=1.44; CI: 1.30-1.59; p&amp;lt;0.001), colonoscopy (aOR=1.43; CI: 1.29-1.57; p&amp;lt;0.001), flex sigmoidoscopy (aOR=1.27; CI: 1.13-1.41; p&amp;lt;0.001), or FOBT (aOR=1.13; CI: 1.02-1.25; p&amp;lt;0.016). The CRC knowledge item answered correctly most often was “colon cancer can start as a polyp, which is a small growth found in the colon” (97%) and least often was “colon cancer is most often caused by a person's behavior or lifestyle” (26%). A CRC knowledge index score (range=0-14) represented total number of correct responses. A one unit increase in knowledge score significantly increased respondents being more likely to have had any CRC screening test (aOR=1.05; CI: 1.02-1.10; p&amp;lt;0.004), colonoscopy (aOR=1.05; CI: 1.02-1.09; p&amp;lt;0.004), or FOBT (aOR=1.04, CI: 1.00-1.07; p=0.043). There were also statistically significant differences by race and gender. Conclusion: Generally, there were high levels of awareness and knowledge scores, but modest participation in CRC screening. Higher levels of awareness and knowledge showed increased likelihood of CRC screening, yet CRC screening rates continue to be lower pointing to the need for interventions in addition to those focused on awareness and knowledge to improve adherence to recommended screening guidelines and reduced CRC cases. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B112.

Detection of locally advanced breast cancer in the I-SPY TRIAL (CALGB 150007/150012, ACRIN 6657) in the interval between routine screening

1503 Background: It is assumed that most locally advanced breast cancers (LABC) could be detected at an earlier stage with routine screening. However, LABCs may present between screens as interval cancers (IC). ICs present at an earlier age, with higher grade, larger size, and are associated with lower survival, compared to screen-detected cancers (SDC), and comprise 17% of cancers from population-based screening programs. We evaluated the screening history in patients with LABCs from the I SPY TRIAL, to determine the frequency of screening and ICs. Methods: Of 221 pts enrolled in the I-SPY TRIAL, a multisite neoadjuvant study for women with LABCs &gt; 3cm in size, screening history and presentation were retrospectively collected for 154. Two groups, screened (S), defined as a mammogram within 2 years, or non screened (NS), previous mammogram more than 2 years prior, were evaluated (Table). The frequency of ICs at 1 and 2 years was determined in S pts. Frequency of mammographically occult (MO) tumors was determined for all. Results: Of the total, 99 (64%) and 55 (36%) were NS and S, respectively. Mean tumor size for all pts was 6.7cm. Only 11 (20%) of S pts were SDCs and 44 (80%) were ICs, with 24 (63%) diagnosed within 1 year and 14 (37%) between 1 and 2 yrs of their last normal mammogram. 24 (24%) NS patients were younger than the recommended screening age of 40; in the remaining 75 pts, 9 (12%) were MO. Only 20% of IC tumors were MO. ICs were of higher grade (44% vs 11% grade III), and tumor size (7.0cm vs 4.4cm) than their SDC counterparts. 80% of cancers detected in I SPY were NKI70 gene test poor prognosis. Relationship to breast density and subtype is currently being assessed. Conclusions: Women presenting with LABCs have a high likelihood (80%) of an IC. This suggests that the growth rate of LABCs precludes early detection by conventional screening. Understanding the biology of ICs will be important to develop better strategies for prevention and early detection. [Table: see text] No significant financial relationships to disclose.

The future of cytology laboratories

This presentation will consider the impact of established and potential changes to cervical screening practice on the structure and organisation of cervical cytology laboratories in the UK. Although full roll out of liquid based cytology in England will not be achieved until 2008, implementation of liquid‐based cytology (LBC) combined with the change in the screening age range and frequency has already resulted in a decrease in the total number of tests examined despite an increased number of women aged 25–64 being screened, reflecting a more efficient screening programme with fewer unnecessary tests outside the recommended screening age range [1]. Laboratories in England and Scotland have reported a decreased workload and increased productivity and efficiency, with no adverse effect on quality [2–4]. There is a growing mismatch between screening workload and capacity, with the potential to achieve laboratory reconfiguration within a managed network, as recommended in the Carter report [5]. However the potential for conflict between the Carter report recommendations and the autonomy of NHS foundation trusts will need to be addressed if laboratory reconfiguration is to be achieved.LBC provides the platform for automation of the screening process and human papillomavirus (HPV) and other evolving molecular testing. The MAVARIC trial due to report in 2010 will inform the decision about the adoption or otherwise of automation in the NHS Cervical Screening Programme (NHSCSP). In previous studies the systems currently under evaluation (Focal Point™ GS and ThinPrep® Imager) have been shown to increase productivity with no loss of sensitivity or specificity [6,7]. The adoption of automation in cervical screening will be a further driver for laboratory reconfiguration by amalgamation of workloads and an extended working day to achieve cost‐effective utilization of the equipment. It may also call into question the role of the cytology screener as currently utilized in the UK cervical screening programmes.Whilst the results of the ARTISTIC and TOMBOLA trials are awaited, sentinel sites have been established to evaluate the practical implications of introducing HPV testing for triage of low‐grade cytological abnormalities and follow up after treatment of CIN. A recent study from the USA suggests that the adoption of primary HPV testing in conjunction with cytology screening in women aged 30 years and older would result in a 30% reduction in the number of cervical screening tests performed [8]. It is likely that if HPV testing is adopted there will be a further reduction in laboratory workload, and as such HPV testing will be another driver for laboratory reconfiguration.Similarly, a modelling study from the UK predicted that HPV 16/18 vaccination of a cohort of 12‐year‐old girls would result over the lifetime of the cohort in a 23% reduction in the number of abnormal cytology tests [9], assuming that vaccine protection lasted for life and the introduction of vaccination did not also allow a reduction in screening frequency [10]. Furthermore, falling lesion prevalence is likely to decrease both the sensitivity and specificity of screening cytology tests and may be a driver for automation or the adoption of primary screening by HPV testing with secondary cytology triage [10].In summary, LBC implementation and change in the screening age range and frequency has been an initial driver to laboratory reconfiguration, in accordance with political objectives. In the longer term, this may be accelerated by automation, HPV testing and HPV vaccination and will also demand a revision of laboratory staffing levels and skill mix. Potential models of laboratory configuration and staffing will be outlined. However, whether all the developments described above are affordable, measured against manual test evaluation estimated to prevent up to 4500 deaths per annum in England at an annual cost of about £160 million remains to be determined [11].

Epidemiology of Breast Cancer in Young Women

Breast cancer is a rare disease in young women, yet is the leading cause of cancer deaths in all ethnic groups in the United States and many parts of the world. The epidemiology for breast cancer in young women is reviewed, focusing on women under 40, prior to the recommended screening age. Specific age comparison groups used and results for young women vary in the literature, yet there are some common results. Young women have low incidence rates of breast cancer compared to older women. However, cancer incidence increases at a faster rate with increasing age in young women. Their cancers tend to be larger and higher grade with poorer prognostic characteristics, resulting in a higher risk of recurrence and death from breast cancer when compared to older women. Many of the usual risk factors for breast cancer in older women also increase risk in younger women including increasing age, Black race, family history, later age at first birth and menarche, radiation exposure and lack of physical activity. Risk factors that have specific relevance to young women include reproductive factors, history of induced abortion or miscarriage, oral contraceptive use, smoking, and radiation exposure, most specifically for treatment of Hodgkin Disease.

Overview of important cervical cancer screening process values in European Union (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness

The objective was the evaluation of the (cost-)effectiveness of cervical cancer screening in the European Union (EU) countries. Data were collected on recommended screening age ranges and intervals, coverage, proportion of non-negative smears and smear use. Estimates reported by representatives of each participating Member State were compared, and used as input for model based on (using the MISCAN simulation model for cancer screening) effectiveness and cost-effectiveness calculations. Differences in coverage from below 50 to 82% resulted in more or less proportional differences in expected percentage life-years lost reduction, almost regardless of differences in 7–50+ smears recommended in a lifetime. Differences in screening intensity (resulting from the recommended number of smears per lifetime and the number of excess smears on top of these recommendations) resulted in more than 2-fold difference in the expected number of smears per percentage life-years lost reduction. (Cost-)effectiveness predictions would have greatly improved if estimates of long-term coverage had also been available. To conclude, estimates for a restricted set of well defined parameters — a few for short and long-term coverage and one for the total number of smears — are quite useful for country-specific (cost-)effectiveness evaluations. The main, and to some extent, unsolvable problem for further improvement of the analysis is the lack of reliable country-specific estimates for the background risk of cervical cancer in women eligible for screening in the near future.