Routine Cancer Screening Research Articles

Impact of COVID-19 on delay in cancer diagnostic testing.

e18786 Background: Early diagnosis is key to the best treatment options and possible outcomes for cancer patients. However, the COVID19 pandemic has put a heavy burden on the US healthcare system, causing hospitals and medical centers to stop or delay routine cancer screenings such as mammograms, pap tests, colonoscopies, CT scans and PSA assays. Subsequently, cancer diagnostic testing and cancer patient care have also been disrupted. Methods: To determine the extent of cancer diagnostic testing that was impacted during the COVID 19 pandemic in 2020, we analyzed the changes in cancer test volume at NeoGenomics Laboratories Inc. between 2019 and 2020, and especially between March and June 2020. Unique patient test counts were categorized by cancer types as determined by the diagnostic ICD 10 code C00-D49 (with a minimum of 100 tests in 2019). Results: Comparing test volumes in 2020 to 2019, an overall decrease in tests ordered in 2020 was seen for multiple cancers. These cancers include malignant neoplasms of breast (16%) and malignant neoplasm of bronchus and lung (19%), followed by malignant neoplasm of colon, polycythemia vera, and Hodgkin lymphoma. In addition, a decrease in benign cancers, and decreases in benign neoplasm of colon, rectum, anus and anal canal was observed. To determine if the US stay-at-home order implemented between March and early June 2020 had affected test volume, month-to-month comparison shows the greatest impact in test volume in malignant neoplasm of breast: a 28% decrease comparing April 2020 to April 2019, and a 32% decrease comparing May 2020 to May 2019. Similarly, a 24% and 33% decrease were seen in malignant neoplasm of bronchus and lung for the same months. Individual tests specific for breast and lung cancer also showed similar decreases: 49-56% decrease for Breast Triple Stain (CK5 + p63 + CK 8/18), 11-41% decrease for ER test, and up to 39% decrease for HER2 diagnostic tests. Tests for ALK fusions for lung cancer showed decreases in test volume ranging from 15% to 30% during April, May and June 2020 as compared to 2019. Interestingly, we found that the total test volumes for each age group (increments of 10 up to age 80) decreased April and May 2020 as well, compared to April and May 2019. We did not see a difference in test volume decreases based on patient gender. Conclusions: There was a decrease in cancer tests ordered during the pandemic in 2020 for most cancer types, with a large decrease found in breast, lung and colon cancer. The sharp decrease in breast cancer tests is important to note as breast cancer has recently been identified as the most diagnosed form of cancer, surpassing lung cancer. This impact in cancer testing may translate to delayed diagnosis and treatment options. It remains to be seen whether this will lead to more aggressive cancer treatments, or to a greater patient mortality. It is imperative that we continue to monitor and screen patients for cancer as the pandemic continues or during any healthcare crisis in the future.

Reductions in cancer screening: The consequence of changes in routine care during the COVID-19 pandemic.

10550 Background: The COVID-19 pandemic imposes significant impact on daily activities with regard to public health orders and individual responses to the pandemic. Much of the direct or indirect impact is potentially in reductions in healthcare encounters for services such as preventive care. Here, we quantified changes in cancer screening rates to better understand the impact of the evolving COVID-19 implications and shifts in health-seeking behaviors. Methods: We conducted a retrospective analysis of cancer screening rates during March-June 2019 (pre-COVID-19) and March-June 2020 (post-COVID-19 restrictions), using Optum’s de-identified Clinformatics Data Mart Database which includes Medicare and commercially insured members. Members meeting age and/or sex criteria as detailed in the United States Preventive Services Task Force recommendations for breast, colorectal, lung, prostate, and cervical cancer screening represented the eligible membership for screening. Procedure and laboratory services were used to identify those who received cancer screening. Analyses were conducted cross-sectionally by cancer screening type. Results: Eligible cohorts were identified from insured members within March-June 2019 and 2020 (2019: 17,931,318; 2020: 17,521,411). The percent of eligible members screened in March-June 2019 was 19.3%, 9.4%, 16.7%, 0.4%, and 7.8% for breast, cervical, prostate, lung, and colorectal cancer, respectively. Changes in screening rates from 2019 to 2020 are summarized in Table, with the sharpest decline in April. The percent change from 2019 to 2020 during the combined March-June period for each cancer screening type was statistically significant (p<0.0001). Conclusions: Routine cancer screening rates from March-June 2020 showed meaningful reductions when compared to the same period in 2019, with substantial declines during the initial peak of the pandemic in April. These declines may be impacted by variations in regional restrictions with tighter restrictions leading to larger screening declines and loosening restrictions reflecting catch-up screening. Efforts to promote cancer screening in a safe and timely manner are crucial given individual risk factors, to reduce later stage cancer diagnoses and improve clinical outcomes.[Table: see text]

Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy)

We conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p < 0.001), if they had to wait more than 5 days from II level test to end of diagnostic procedures (p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p < 0.001) and if they had no previous participation to screening tests (p < 0.001). Our results are consistent with previous studies, and encourages the implementation and innovation of the organizational characteristics for breast cancer screening. The success of screening programs requires an efficient indicators monitoring strategy to develop and evaluate continuous improvement processes.

Managing patients with high-risk breast lesions, precursors on the breast neoplasia pathway.

Breast cancer remains the most commonly diagnosed cancer among women. Imaging abnormalities may be noted on routine breast cancer screenings and require biopsy for further evaluation. Atypia and carcinoma in situ are nonmalignant lesions identified via breast biopsy and are associated with an increased risk of invasive carcinoma. Because of the lack of specialized breast cancer prevention and risk reduction programs, patients may not be able to access optimal management of the various subtypes of atypia and carcinoma in situ. By understanding the pathology of high-risk breast lesions and the resulting elevated cancer risk, healthcare providers, specifically primary care providers, can better counsel, manage, and treat patients to provide comprehensive quality care.

The Impact of Longitudinal Surveillance on Tumor Thickness for Melanoma-Prone Families with and without Pathogenic Germline Variants of CDKN2A and CDK4

Skin cancer screening is routinely performed for members of melanoma-prone families, but longitudinal studies evaluating the efficacy of surveillance in this high-risk population are lacking. We evaluated thickness for first primary melanomas diagnosed in melanoma-prone families (≥2 individuals with melanoma) enrolled in NCT00040352 (NCI familial melanoma study) from 1976 through 2014; enrolled patients received routine skin cancer screening and education about skin self-exams. We used linear and ordinal logistic regression models adjusted for gender and age with a generalized estimating equations approach to report changes in thickness and tumor (T) stage over time, comparing outcomes for NCI cases diagnosed before (pre-study) versus after study participation (prospective) and for NCI cases versus nonfamilial cases [Surveillance, Epidemiology, and End Results (SEER) 9 registries]. Tumor thickness was evaluated for 293 NCI (pre-study = 246; prospective = 47) patients. Compared with NCI pre-study cases, NCI prospective melanomas were thinner (0.6 vs. 1.1 mm; P < 0.001) and more likely to be T1 stage [39/47 (83%) vs. 98/246 (40%); P < 0.001]. Similar findings (P < 0.05) were observed for familial cases with and without germline CDKN2A and CDK4 mutations. Peters-Belson modeling suggested that calendar period effects of decreasing thickness in the general population (SEER 9) did not fully explain thickness trends in NCI families. Participation in a longitudinal surveillance program providing skin cancer screening and education about skin self-exams was associated with thinner melanomas for members of melanoma-prone families. The study findings support the clinical benefit of screening (physician and self) for this high-risk population.

Costs of routine skin cancer screening in Germany: a claims data analysis.

In 2008, a routine skin cancer screening (rSCS) programme was implemented in Germany. Since then, its medical and economical effects have been evaluated and critically discussed. To compare costs for patients diagnosed with skin cancer with preceding rSCS vs. those diagnosed without rSCS. We conducted a retrospective observational study using claims data from a large German health insurance company for the period 2013-2016. We applied entropy balancing, difference-in-differences estimation and generalized linear models to compare costs for patients with cancer with and without rSCS. We conducted sensitivity analyses to test for the robustness of results. In total, 12790 patients with skin cancer were included in the analyses, of whom 6041 were diagnosed by rSCS. Treatment costs were €467 higher for patients in the control group (without rSCS). However, the screening costs were higher. For all people covered by the health insurance company, there were additional costs of €1339-1431 per patient with skin cancer diagnosed by rSCS. Thus, total costs, including costs for treatment and screening, were €872-964 higher for patients diagnosed by rSCS. Based on our analysis, rSCS has the potential to reduce treatment costs; however, the screening costs exceed these savings.

Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States.

BackgroundIn response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends.MethodsWe used Google Trends to query search terms related to cancer types for short-term (September 2019–September 2020) and long-term (September 2016–September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation.ResultsGeneral search interest declined for all cancer types beginning in March 2020, with changes in search interest for “Breast cancer,” “Colorectal cancer,” and “Melanoma” of − 30.6%, − 28.2%, and − 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for “Telemedicine” has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020.ConclusionWe observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10552-021-01409-1.

Knowledge, Attitudes, and Experiences of Anal Cancer and Anal Cancer Screening Among a Clinical Sample of Hispanic Women.

Anal cancer screening has been recommended for women with lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation recipients. This study described and compared knowledge, attitudes, and experiences related to anal cancer and anal cancer screening between women at high risk for anal cancer and their counterparts. This is a cross-sectional study within colposcopy and gynecology oncology clinics in Puerto Rico; 278 women 21 years or older and with prior diagnosis of gynecological neoplasia completed an interviewer-administered questionnaire. Women were categorized according to their medical history as being high risk or non-high risk for anal cancer. The high-risk group included women with a history of lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation. Overall, 40.7% of the study population were at high risk for developing anal cancer. History of anal cancer screening was low among high-risk and non-high-risk women (11.5% vs 5.6%, p > .05). Less than 1% of all women reported to have had a high-resolution anoscopy. Most women (87.6%) had little knowledge about anal Pap test but were willing to have one if their doctors recommended it (96.5%). No major differences in knowledge, attitudes, or screening history were observed between high-risk and non-high-risk women. Although experts do not recommend routine anal cancer screening for the general population, they do recommend it for women within certain high-risk groups. Study findings highlight the importance of increasing education and awareness of anal cancer among high-risk patients and physicians, to promote better preventive methods, achieve early detection, and improve disease outcomes.

Secondary malignancies in long-term ovarian cancer survivors: results of the ‘Carolin meets HANNA’ study

ObjectiveTo evaluate the rate of secondary malignancies in long-term survivors with ovarian cancer.MethodsLong-term survivors with ovarian cancer (survival ≥8 years after initial diagnosis) with multiple malignancies were identified within the...

Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey

BackgroundNER1006 (Plenvu®, Salix Pharmaceuticals, Bridgewater, NJ) is a 1 L polyethylene glycol bowel preparation indicated for colonoscopy in adults. A US online survey assessed real-world ease of use and treatment satisfaction in individuals who received NER1006.MethodsAdults were recruited from 444 US community gastrointestinal practices and provided a kit number for enrollment into an online survey to be completed within 2 weeks. Survey questions evaluated colonoscopy history and prior bowel preparation(s) prescribed, patient experience during NER1006 administration, and patient satisfaction with the bowel preparation process. A 9-point predefined grading scale was used to evaluate ease of NER1006 preparation and consumption (range, 1 “very difficult” to 9 “very easy”); the perceived importance of volume requirement and clear liquid options (range, 1 “not important at all” to 9 “very important”); and patient satisfaction (range, 1 “not satisfied at all” to 9 “very satisfied”).Results1630 patients were enrolled, 1606 underwent colonoscopy, and 1598 completed the survey between September 15, 2018 and February 28, 2019. Among 1606 patients who had a colonoscopy, 62.5% were female, and the mean patient age was 54.4 years (range 18–89 years). Most patients (74.7%) did not report a family history of colon cancer, 62.6% had undergone prior colonoscopy, and 64.8% were undergoing colonoscopy for routine colorectal cancer screening. A majority (76.1%) of patients who completed the survey reported that NER1006 was very easy to prepare and take, and 89.9% were very or moderately satisfied with NER1006 overall. Most (97.6%) patients reported consuming all or most of the bowel preparation. Among 1005 patients with previous bowel preparation use, 84.7% indicated that their experience with NER1006 was much better or better (65.3%) or about the same (19.4%) compared with previously used bowel preparations, while only 15.3% rated NER1006 as worse or much worse.ConclusionsIn this first real-world, US multicenter survey, patient-reported experience with NER1006 as a bowel preparation for colonoscopy was favorable and adherence was high. The majority of patients were very or moderately satisfied with the overall experience and found it much better/better than previously used bowel preparations.Trial registration: Not applicable

Robustness of convolutional neural networks in recognition of pigmented skin lesions

A basic requirement for artificial intelligence (AI)-based image analysis systems, which are to be integrated into clinical practice, is a high robustness. Minor changes in how those images are acquired, for example, during routine skin cancer screening, should not change the diagnosis of such assistance systems. To quantify to what extent minor image perturbations affect the convolutional neural network (CNN)-mediated skin lesion classification and to evaluate three possible solutions for this problem (additional data augmentation, test-time augmentation, anti-aliasing). We trained three commonly used CNN architectures to differentiate between dermoscopic melanoma and nevus images. Subsequently, their performance and susceptibility to minor changes ('brittleness') was tested on two distinct test sets with multiple images per lesion. For the first set, image changes, such as rotations or zooms, were generated artificially. The second set contained natural changes that stemmed from multiple photographs taken of the same lesions. All architectures exhibited brittleness on the artificial and natural test set. The three reviewed methods were able to decrease brittleness to varying degrees while still maintaining performance. The observed improvement was greater for the artificial than for the natural test set, where enhancements were minor. Minor image changes, relatively inconspicuous for humans, can have an effect on the robustness of CNNs differentiating skin lesions. By the methods tested here, this effect can be reduced, but not fully eliminated. Thus, further research to sustain the performance of AI classifiers is needed to facilitate the translation of such systems into the clinic.

Routine Breast Cancer Screening in Average-Risk Women Younger Than 50 Years: Current Paradigms Based on National Guidelines.

Breast cancer poses a large health care burden. More than 270,000 women are diagnosed with breast cancer every year in the United States alone, and more than 40,000 women will die from the disease over the same period. Advances in routine screening and curative treatment options have led to mean 5-year survival rates for localized and regional disease of 98.9% and 85.7%, respectively. Diagnosis at an early stage, often due to routine screening, represents one of the most important prognostic factors for survival. Routine mammography screening in average-risk women 50 years and older has reduced the age-adjusted mortality rate from breast cancer by 34% just over the past 20 years.2,3 While there is consensus among national health organizations regarding the benefits of routine mammographic screening in women 50 years and older, screening recommendations for average-risk women aged between 40 and 49 years vary. Differences in screening recommendations among national organizations largely reflect variations in assessment of the benefit-to-harm ratio of screening women aged between 40 and 49 years who are less likely to develop breast cancer, compared with older women. Women who do develop breast cancer in this age group, however, are more likely to develop more aggressive disease.4,5 Over the past decade, this has become an increasingly important topic of discussion as breast cancer shifts to a younger age of onset.1 In this review, we examine the risks and benefits of routine breast cancer screening starting at age 40 at the individual level, followed by an evaluation of the role of advanced imaging techniques in screening women on a population level.

Dealing with cancer screening in the COVID-19 era.

This article aims to alert health professionals for cancer screening in the face of the possibility of new waves of disease. A narrative review was conducted through a search in MEDLINE, Lilacs, Chinese Biomedical Literature Database, and international medical societies publications. Breast cancer: in high-risk patients (confirmed familial cancer syndrome or with high-risk tools scores), clinicians should act according to usual recommendations; in average-risk individuals, consider screening with mammography with a longer time span (maximum of two years). Cervical cancer: women turning 25 years old who have already been immunized and with no previous Pap test can have the test postponed during the pandemic; if there is no previous dose of Human Papillomavirus vaccination, initiation of screening should be recommended following a more rigid approach for COVID prevention; in women over 30 years of age who have never participated in cervical screening, the first screening exam is also essential. Colorectal cancer: if the individual is at elevated risk for familial cancer, the screening with colonoscopy according to usual recommendations should be supported; if at average risk consider screening with Fecal Occult Blood Test. Prostate cancer: there is a trend to postpone routine prostate cancer screening until the pandemic subsides. The decision to keep cancer screening must be discussed and individualized, considering the possibility of new waves of COVID-19.

Testosterone therapy and breast histopathological features in transgender individuals

Testosterone therapy (TT) is administered to enhance masculinization in transgender individuals. The long-term effect of exogenous testosterone on breast tissues remains unclear. Our study evaluated the modulation of breast morphology by TT in transgender individuals with special attention to duration of TT. We reviewed 447 breast surgical specimens from gender affirming chest-contouring surgery, and compared histopathological findings including degree of lobular atrophy, and atypical and non-atypical proliferations between subjects who did (n = 367) and did not (n = 79) receive TT. TT for one patient was unknown. TT for >12 months was associated with seven histopathological features. Longer duration of TT was significantly associated with higher degrees of lobular atrophy (p < 0.001). This relationship remained significant after accounting for age at surgery, ethnicity, body mass index, and presurgical oophorectomy (adjusted p < 0.001). Four types of lesions were more likely to be absent in breast tissues exposed to longer durations of TT: cysts (median = 16.2 months; p < 0.01; adjusted p = 0.01), fibroadenoma (median = 14.8 months; p = 0.02; adjusted p = 0.07), pseudoangiomatous stromal hyperplasia (median = 17.0 months; p < 0.001; adjusted p < 0.001), and papillomas (median = 14.7 months; p = 0.04; adjusted p = 0.20). Columnar cell change and mild inflammation were also less likely to occur in subjects receiving TT (p < 0.05), but were not linked to the duration of TT. Atypia and ductal carcinoma in situ were detected in 11 subjects (2.5%) all of whom received TT ranging from 10.1 to 64.1 months. The incidental findings of high-risk lesions and carcinoma as well as the risk of cancer in residual breast tissue after chest-contouring surgery warrant the consideration of culturally sensitive routine breast cancer screening protocols for transgender men and masculine-centered gender nonconforming individuals. Long-term follow-up studies and molecular investigations are needed to understand the breast cancer risk of transgender individuals who receive TT.

1528. Prevalence of Human Papillomavirus Infection and Cervical Intra-Epithelial Lesions in A Subset of Arab American Women in Southeast Michigan

BackgroundThe Pap smear is a screening examination that detects abnormal cervical cells and may be paired with human papillomavirus (HPV) testing in order to detect high-risk, oncogenic HPV strains. The incidence of cervical cancer varies among groups due to racial and ethnic disparities, and 80% of cases occur in developing countries. Mortality rates for cervical cancer in the Middle East are disproportionately higher when compared to developed countries. Our study aims to assess the prevalence of HPV and cervical cancer among a subset of Arab-American women in southeast Michigan.MethodsThe study is a retrospective chart review of women who presented for routine cancer screening as part of the Breast and Cervical Cancer Control Program (BCCCP), at the Arab-American Center for Economic and Social Services Clinic in southeast Michigan between 2003-2019. Paper charts were reviewed for information such as age, date of birth, monthly income, tobacco use, cervix-related gynecological examination performance, cervical cytology results, and HPV testing results. Women between the ages of 21 and 65 were included. In instances where cytology was performed, results and details of high-risk HPV testing were documented. In instances where high-risk HPV testing was performed, negative results were documented as such, and positive results were documented as either positive for HPV 16, 18, or other high-risk strains, or unknown if serotype testing was not available.ResultsA total of 464 charts from the BCCCP program were reviewed. All women included were uninsured and had immigrated from Middle Eastern countries, including Yemen and Lebanon. The average age of the women was 48.3 years. Of 464 women, 6% (n=28) of women declined to have a Pap smear. 85 women reported they had never had a Pap smear. Of the 436 women who did undergo Pap smear, 42 women (9.6%) had an abnormal pap smear. The remaining results are summarized in Table 1.Table 1 ConclusionOur study results show a trend toward HPV serotype 16 and other serotypes compared to HPV serotype 18 in Arab-American women who recently immigrated to the United States. However, this needs to be studied on a larger cohort of patients to determine if these serotypes are more common among this ethnicity compared to the general population.DisclosuresMarcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

Performance of Digital Breast Tomosynthesis, Synthetic Mammography, and Digital Mammography in Breast Cancer Screening: A Systematic Review and Meta-Analysis.

Our objective was to perform a systematic review and meta-analysis comparing the breast cancer detection rate (CDR), invasive CDR, recall rate, and positive predictive value 1 (PPV1) of digital mammography (DM) alone, combined digital breast tomosynthesis (DBT) and DM, combined DBT and synthetic 2-dimensional mammography (S2D), and DBT alone. MEDLINE and Embase were searched until April 2020 to identify comparative design studies reporting on patients undergoing routine breast cancer screening. Random effects model proportional meta-analyses estimated CDR, invasive CDR, recall rate, and PPV1. Meta-regression modeling was used to compare imaging modalities. All statistical tests were 2-sided. Forty-two studies reporting on 2 606296 patients (13 003 breast cancer cases) were included. CDR was highest in combined DBT and DM (6.36 per 1000 screened, 95% confidence interval [CI] = 5.62 to 7.14, P < .001), and combined DBT and S2D (7.40 per 1000 screened, 95% CI = 6.49 to 8.37, P < .001) compared with DM alone (4.68 per 1000 screened, 95% CI = 4.28 to 5.11). Invasive CDR was highest in combined DBT and DM (4.53 per 1000 screened, 95% CI = 3.97 to 5.12, P = .003) and combined DBT and S2D (5.68 per 1000 screened, 95% CI = 4.43 to 7.09, P < .001) compared with DM alone (3.42 per 1000 screened, 95% CI = 3.02 to 3.83). Recall rate was lowest in combined DBT and S2D (42.3 per 1000 screened, 95% CI = 37.4 to 60.4, P<.001). PPV1 was highest in combined DBT and DM (10.0%, 95% CI = 8.0% to 12.0%, P = .004), and combined DBT and S2D (16.0%, 95% CI = 10.0% to 23.0%, P < .001), whereas no difference was detected for DBT alone (7.0%, 95% CI = 6.0% to 8.0%, P = .75) compared with DM alone (7.0%, 95.0% CI = 5.0% to 8.0%). Our findings provide evidence on key performance metrics for DM, DBT alone, combined DBT and DM, and combined DBT and S2D, which may inform optimal application of these modalities for breast cancer screening.

Risk of solid malignancies in bullous pemphigoid: A large-scale population-based cohort study.

The association of bullous pemphigoid (BP) with solid malignancies (SM) is a matter of controversy, as previous studies produced inconclusive findings. The aim of this study was to assess the risk of SM among patients with BP and to evaluate whether a history of SM predisposes individuals to develop subsequent BP. A population-based cohort study was performed comparing BP patients (n=3924) with age-, sex- and race-matched control subjects (n=19280) with regard to incident cases of SM. Adjusted hazard ratios (HR) and adjusted odds ratios (OR) were estimated by Cox regression and logistic regression, respectively. The incidence of SM was 13.4 (95% confidence interval [CI], 11.6-15.3) and 14.3 (95% CI, 13.5-15.1) per 1000person-years among patients with BP and controls, respectively. BP was not associated with an increased risk of SM (adjusted HR, 0.90; 95% CI, 0.77-1.05). Additionally, a history of SM was not related to the risk of subsequent BP (adjusted OR, 1.00; 95% CI, 0.90-1.10). In a stratified analysis, patients with BP had an increased risk of uterine cancer (adjusted HR, 2.56; 95% CI, 1.39-4.72) unlike the 18 remaining analyzed types of SM. Relative to BP patients without SM, those with BP and SM were older, had a male predominance, a higher prevalence of smoking, a higher burden of comorbidities and comparable survival rates. Although patients with BP do not experience an overall increased risk of developing SM, they are more likely to have uterine cancer. Our findings argue against routine extended cancer screening for patients with incident BP, but raise the awareness of uterine cancer among females with BP.

The Fear Returns: Messaging in the Age of Coronavirus Disease 2019 (COVID-19)

The Fear Returns: Messaging in the Age of Coronavirus Disease 2019 (COVID-19)

Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: associations with recommendations.

Treatment and diagnostic recommendations are often made in clinical guidelines, reports from advisory committee meetings, opinion pieces such as editorials, and narrative reviews. Quite often, the authors or members of advisory committees have industry ties or particular specialty interests which may impact on which interventions are recommended. Similarly, clinical guidelines and narrative reviews may be funded by industry sources resulting in conflicts of interest. To investigate to what degree financial and non-financial conflicts of interest are associated with favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. We searched PubMed, Embase, and the Cochrane Methodology Register for studies published up to February 2020. We also searched reference lists of included studies, Web of Science for studies citing the included studies, and grey literature sources. We included studies comparing the association between conflicts of interest and favourable recommendations of drugs or devices (e.g. recommending a particular drug) in clinical guidelines, advisory committee reports, opinion pieces, or narrative reviews. Two review authors independently included studies, extracted data, and assessed risk of bias. When a meta-analysis was considered meaningful to synthesise our findings, we used random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs), with RR > 1 indicating that documents (e.g. clinical guidelines) with conflicts of interest more often had favourable recommendations. We analysed associations for financial and non-financial conflicts of interest separately, and analysed the four types of documents both separately (pre-planned analyses) and combined (post hoc analysis). We included 21 studies analysing 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews. We received unpublished data from 11 studies; eight full data sets and three summary data sets. Fifteen studies had a risk of confounding, as they compared documents that may differ in other aspects than conflicts of interest (e.g. documents on different drugs used for different populations). The associations between financial conflicts of interest and favourable recommendations were: clinical guidelines, RR: 1.26, 95% CI: 0.93 to 1.69 (four studies of 86 clinical guidelines); advisory committee reports, RR: 1.20, 95% CI: 0.99 to 1.45 (four studies of 629 advisory committee reports); opinion pieces, RR: 2.62, 95% CI: 0.91 to 7.55 (four studies of 284 opinion pieces); and narrative reviews, RR: 1.20, 95% CI: 0.97 to 1.49 (four studies of 457 narrative reviews). An analysis combining all four document types supported these findings (RR: 1.26, 95% CI: 1.09 to 1.44). One study investigating specialty interests found that the association between including radiologist guideline authors and recommending routine breast cancer screening was RR: 2.10, 95% CI: 0.92 to 4.77 (12 clinical guidelines). We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.

Abstract PO-251: Examining facilitators and barriers to cancer screening among Black firefighters in South Florida

Abstract Purpose: Epidemiologic studies of cancer among U.S. firefighters suggest a disproportionate burden of select cancer types including respiratory, gastrointestinal, skin, and kidney when compared to the general population. Although routine colorectal and whole-body skin cancer screening is widely recommended, screening rates among firefighters remain low. The National Fire Protection Association estimates a 1.1 million firefighter workforce, most of whom are Caucasian male, however, sub-groups of women, Hispanic, sexual minority, and Black firefighters are growing. In the present study we describe facilitators and barriers to cancer screening among Black firefighters. Method: A semi-structured interview script was used to conduct five focus group sessions of 45 to 60-minute duration with a total of 22 Black firefighters in South Florida between December 2019 and June 2020. A 20-item demographic survey was administered prior to the start of the interview. Data analysis was conducted using a grounded theory approach and NVIVO 12 software. Qualitative data was analyzed for themes and patterns. Results: Among participating Black firefighters, 90.9% were male, 4.6% Hispanic, 77.3% married, 68.1% with college/master’s educational attainment, 72.7% with private health insurance, 72.7% had a personal doctor, and a group mean age was 44 years (SD ± 8.7 years). Across all focus group sessions, the following three major themes emerged as facilitators and barriers to cancer screening: 1) societal culture of machismo and familial culture; 2) cancer education and cancer awareness; and 3) individual faith. Black firefighters describe culture as influencing health decisions and behaviors throughout their lives, including food choices, receiving a health screening, or visiting a doctor. A second prevalent theme focused on education and cancer awareness; specifically, Black firefighters did not feel comfortable with doctors, particularly because they were Black and firefighters. Many felt that their doctors are not as aware of racial health differences as they should be, and they had to bring information to their doctors about firefighters’ unique job exposures. Lastly, a third theme describing individual faith influencing cancer screening practices frequently emerged. Many participants reported faith as being very important to them, however, they would not let religious beliefs prevent them from seeking medical interventions when needed. Conclusion: Black societal culture of machismo, cancer education and awareness, and individual faith were identified as facilitators and barriers of cancer screening among Black firefighters in South Florida. Strategies to improve cancer screening and prevention for Black firefighters should consider these factors in the design of workplace cancer interventions for this unique minority occupational subgroup. Citation Format: Kemi Ogunsina, Natasha Solle, Lauren A. Murphy, Debi Brannan, Keith Bell, William McAlister, Erin Kobetz, Alberto Caban- Martinez. Examining facilitators and barriers to cancer screening among Black firefighters in South Florida [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-251.