Routine Cancer Screening Research Articles

Promoting oral cancer screening by general practitioners in Australia: Strengthening primary healthcare.

Oral cancer remains a significant public health issue. General practitioners (GPs) can play an important role in raising awareness of oral cancer. This paper explores why providing advice relating to modifiable risk behaviours associated with oral cancer and undertaking routine oral cancer screening are important for GPs in clinical practice. To support GPs, an e-learning module on oral cancer screening, prevention and early detection was established as part of the Oral Cancer Screening and Prevention Program (funded by the Victorian Department of Health). The development of the e-learning module was led by Dental Health Services Victoria in partnership with The Royal Australian College of General Practitioners (RACGP), and the content was developed in consultation with experts from the University of Melbourne, Cancer Council Victoria and the Victorian Comprehensive Cancer Centre. The Oral Cancer: Prevention, early detection and referral e-learning module was launched on the RACGP training website in November 2023.

Rural-Urban Disparities and Trends in Cancer Screening: An Analysis of Behavioral Risk Factor Surveillance System Data (2018-2022).

Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancer screenings. This analysis aimed to examine rural-urban differences in recent trends for being up to date with screenings for breast, cervical, and colorectal cancers. We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible U.S. adults. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year. Prevalence of being up to date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer that dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022 with the odds of up-to-date screening being 14% to 27% lower for rural populations than urban populations. For colorectal and cervical cancer, the odds of being up to date with screenings were lower for rural populations in 2018 and 2020, but there was no significant difference observed in 2022 (colorectal screening OR = 0.96; 95% CI: 0.90, 1.02) (cervical screening OR = 0.97; 95% CI: 0.93, 1.03). There is a concerning trend of decreasing uptake of cancer screenings, which will challenge future efforts in cancer prevention and control efforts. Efforts are needed to better understand factors contributing to the declining uptake of cancer screenings.

Monitoring inequities using routine administrative data: a case study of cancer screening in Ontario, Canada

Abstract Routine cancer screening is a critical primary care service to reduce cancer morbidity and mortality, through early detection, diagnosis, and treatment. We evaluated longitudinal changes in socioeconomic inequities in cancer screening in Ontario, Canada, by using linked provincial health administrative databases including 15.9 million records eligible for cancer screening. The rate of colorectal cancer screening increased between 2011 and 2020 (54% to 62%) with a reduction in the indices of inequity (slope index, SII: from 0.36 to 0.33; relative index of inequity, RII: from 0.69 to 0.54). However, the rate of cervical cancer screening decreased (from 76% to 68%), particularly in deprived areas (RII increasing from 0.47 to 0.54). Access to cancer screening is a challenge in deprived areas. Understanding the socio-economic determinants in access to screening across the life course can help develop tailored interventions to increase health equity.

Mastalgia and Why It Should Be Evaluated With Imaging in Areas Where Use of Breast Cancer Screening Services are Unsatisfactory.

Mastalgia or breast pain is a very common symptom in women attending breast clinic. The aim of this study was to evaluate whether imaging for mastalgia leads to cancer detection in an area where routine breast cancer screening services are underutilized. This prospective study was performed between 1st March 2021 to 31st January 2023 at a tertiary care academic institution of central India. All patients underwent through clinical examination by a surgeon. Then patients were referred for ultrasound and/or X-ray mammography (MMG) depending on age. Cancer detection rate was calculated. The final cohort consisted of 176 patients with mastalgia and without any abnormality on clinical breast examination. Sixteen patients had mass lesion on radiology and core needle biopsy resulted as infiltrating duct carcinoma in 7 patients and benign phylloides tumor in one patient. Overall case detection rate for cancer was 4%. The breast cancer detection rate in patients presenting with mastalgia was low. However, in the absence of routine mammographic screening in the Indian general population, these would have been missed. Hence, diagnostic assessment for mastalgia is an appropriate strategy in countries where routine screening MMG is lacking.

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

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

Abstract B064: Community-informed interventions to address cervical cancer disparities among people experiencing homelessness

Abstract Background: Cervical cancer incidence and mortality rates are up to four-fold higher among people experiencing homelessness (PEH) compared to the housed US population. Even beyond typical social and structural barriers to healthcare, homeless women experience high rates of sexual violence and trauma, often leading to discomfort with cervical cancer screening and delays/refusals of Pap tests. Despite these issues, strategies for appropriate cervical cancer screening in homeless communities are scarce, and no frameworks exist for routine screening in shelters. Methods: Leveraging an established multisectoral community-academic partnership addressing homelessness and health disparities in Indiana, USA, ongoing community-engaged research is examining barriers to cervical cancer screening among PEH and co-designing strategies to address them. Rapid assessment surveys were conducted with PEH at two large homeless service agencies in Indianapolis and Lafayette to document cervical cancer screening coverage and characteristics of individuals who are unscreened/overdue. In-depth interviews explored knowledge of cervical cancer, key barriers and facilitators to screening, and acceptability of shelter-based HPV self-sampling delivered by trusted community health workers (CHW). Results: Of n=167 survey respondents, 48% were white, 38% Black, 7% Hispanic, 7% other. Mean age was 43.18 years, and mean lifetime years of homelessness was 3.18. Nearly half of participants (49%) were unsheltered, 44% stayed at a shelter, the remainder couch-surfed. One third (32%) were unscreened or overdue for screening, far above state and national averages (24% and 22% respectively). The majority (84%) reported wanting to be screened and believing it is important for their health. Provider mistrust and competing priorities surrounding their homelessness were main reported barriers to screening. Qualitative findings identified key benefits, concerns, and preferences for HPV self-sampling, with many participants expressing interest and willingness to adopt this screening method. Conclusion: Despite a vast majority of PEH reporting a desire and willingness to be screened for cervical cancer, key identified barriers limit access for this uniquely vulnerable population. Ongoing qualitative analysis is directly informing community context-specific CHW-delivered cervical cancer education and HPV self- sampling interventions. This work will ultimately lead to broadly implementable strategies for shelter-based routine cancer screening and preventive healthcare delivery for PEH. Citation Format: Natalia M. Rodriguez, Lara Balian, Rebecca Ziolkowski, Xue Case, Kalesia Smith, Janelle Tipton. Community-informed interventions to address cervical cancer disparities among people experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B064.

Migration background and use of preventive healthcare services: Findings of the German Ageing Survey

BackgroundThis study aimed to investigate the relationship between migration background and the utilization of preventive healthcare services.MethodsCross-sectional data from wave 5 in the year 2014, with a sample size of 7,684 individuals, were extracted from the nationally representative German Ageing Survey. The survey included community-dwelling individuals aged 40 years and above, with migration background serving as the primary independent variable. The outcomes measured included participation in cancer screenings, flu vaccinations, and routine health check-ups. Multiple logistic regressions were used to examine the association between migration background and preventive healthcare services.ResultsRegressions showed that the presence of a migration background with personal migration experience (compared with not having a migration background) was associated with a lower likelihood of using preventive healthcare services. More precisely, compared to individuals not having a migration background, individuals with a migration background and personal migration experience had a lower likelihood of routine health check-ups (OR = 0.76, 95% CI: 0.61 to 0.95), flu vaccinations (OR = 0.75, 95% CI: 0.59 to 0.95) and cancer screenings (OR = 0.71, 95% CI: 0.57 to 0.89). In contrast, there was no significant association between the presence of a migration background without personal migration experience (compared with not having a migration background) and the use of preventive healthcare services.ConclusionIn conclusion, results showed differences between individuals without migration background and individuals with migration background (and with personal migration experience) in terms of using preventive healthcare services. It may be helpful to specifically address individuals with migration background (and with migration experience) in terms of using preventive healthcare services.

Cancer Screening in Renal Transplant Recipients: Real-World Data.

Multiple international guidelines have endorsed cancer screening in renal transplant patients. This study aimed to describe a series of patients with post-transplant cancer and to report physicians' adherence to cancer screening guidelines. This is a retrospective study of cancer patients who had a history of renal transplant. Charts of patients who were treated at our institution between 2012 and 2023 were reviewed, patients' clinical data were collected. Thirty-nine patients were identified. The most common types of cancer were lymphoma (n = 9, 23%), squamous cell carcinoma (SCC) of the skin (n = 8, 20.5%), and breast (n = 6, 15.4%). The median age at diagnosis was 56.5 years (range: 16.9 - 70.2), family history of malignancy was depicted in 18 (46.2%) cases. Chart review and patients' questionnaire revealed that increased risk of malignancy was discussed in seven (18%) out of 39 recipients (P < 0.001) at time of transplant, and only three (7.7%, P < 0.001) patients were on post-transplant age-matched cancer screening. The increased risk of malignancy is a serious post-transplant complication. Lymphoma and non-melanoma skin cancer were the most common cancers. Most patients were not offered routine cancer screening; it is important to raise awareness among nephrologists and caregivers regarding the risk of post-transplant malignancy.

Disparities in the Care Disruption During COVID-19 and in its Impacts on the Mental and Physical Well-Being of Cancer Survivors.

Our study explores cancer care disruption among different demographic subgroups. It also investigates these disruptions' impacts on cancer survivors' mental and physical well-being. Pooled cross-sectional survey data. Health Information Trends Survey for Surveillance Epidemiology and End Results, HINTS-SEER. n = 1234 cancer survivors participated in the study and completed the survey. Outcome variables were treatment disruption in cancer care, mental health and physical health perceptions, age, race, education, income, and sexual orientation. Multiple imputations were used to address missing data. Descriptive statistics were conducted to understand the perceptions of care disruption. Partial least squares structural equation models were employed for data analysis, adjusted for socio-demographics. COVID-19 impacted cancer treatment and follow-up appointments (69.45%), routine cancer screening (60.70%), and treatment plans (73.58%), especially among elderly patients. It changed the interactions with health care providers (HCP) for 28.03% of the participants. Older adults were 2.33 times more likely to experience treatment appointment disruptions. People who thought their contact with their doctors changed during COVID-19 were more likely to be older adults (65 or more) (OR = 3.85, P = .011), white (OR >1, P = .002), and with higher income (OR = 1.81, P = .002). The changes to cancer treatment and follow-up medical appointments negatively impacted the well-being of the patients (mental: β = -.006, P = .043; physical: β = -.001, P = .006), routine screening and preventative care visits (mental: β = -.029, P = .031; physical: β = -.003, P = .008), and cancer treatment plans (mental: β = -.044, P = .024; physical: β = -.021, P = .040). Our findings underscore the crucial requirement for implementing focused interventions aimed at alleviating the discrepancies in the accessibility of cancer care across diverse demographic groups, particularly during times of emergency, in order to mitigate any potential disruptions in care.

HSD109 Association Between Routine Colorectal Cancer Screening and the Risk of Colorectal Cancer Diagnosed at Advanced Stage and Total Cost of Care Among US Adults

HSD109 Association Between Routine Colorectal Cancer Screening and the Risk of Colorectal Cancer Diagnosed at Advanced Stage and Total Cost of Care Among US Adults

Skin cancer screening recommendations by U.S. cancer centers: Inconsistency with national guidelines.

The incidence of melanoma has increased dramatically over the past four decades, while overall mortality has remained stable. This increase in incidence without a change in overall mortality may be due to overdiagnosis through skin cancer screening. Despite the USPSTF citing insufficient evidence for or against professional skin cancer screening in average-risk adults, U.S. skin cancer screening practices may be leading to overdiagnosis of skin cancers. Two reviewers examined the online recommendations for skin cancer screening of 1113 U.S. cancer centers accredited by the Commission on Cancer, including 66 designated by the National Cancer Institute (NCI). Recommendations on skin cancer screening, such as age, frequency, and patient population (i.e. high-risk of developing skin cancer, "people of color") were documented. We found that 18% of centers (202) recommended professional screening in average-risk adults, 35.8% (399) advised regular self-examination, and only 3.4% (38) cited insufficient evidence for screening practices; 49% of NCI centers (32/66) recommended screening in high-risk adults compared to 13% of non-NCI centers (135/1047; p = 0.0004); 0.45% of centers (5) mentioned the potential harms of screening, while 3.5% (39) specifically recommended screening for people of color. Our study reveals that many U.S. cancer centers advise some form of skin cancer screening despite a lack of evidence for or against these practices. Few centers mentioned the potential harms of screening, including overdiagnosis. This indicates a need for stronger evidence for specific screening guidelines and for greater public awareness of the potential benefits and harms of routine skin cancer screening.

The Effect of Medicare Annual Wellness Visits on Breast Cancer Screening and Diagnosis.

The Medicare Annual Wellness Visit (AWV)-a prevention-focused annual check-up-has been available to beneficiaries with Part B coverage since 2011. The objective of this study was to estimate the effect of Medicare AWVs on breast cancer screening and diagnosis. The National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims (SEER-Medicare), HRSA's Area Health Resources Files, the FDA's Mammography Facilities database, and CMS "Mapping Medicare Disparities" utilization data from 2013 to 2015. Using an instrumental variables approach, we estimated the effect of AWV utilization on breast cancer screening and diagnosis, using county Welcome to Medicare Visit (WMV) rates as the instrument. 66,088 person-year observations from 49,769 unique female beneficiaries. For every 1-percentage point increase in county WMV rate, the probability of AWV increased by 1.7 percentage points. Having an AWV was associated with a 22.4-percentage point increase in the probability of receiving a screening mammogram within 6 months ( P <0.001). There was no statistically significant increase in the probability of breast cancer diagnosis (overall or early stage) within 6 months of an AWV. Findings were robust to multiple model specifications. Performing routine cancer screening is an evidence-based practice for diagnosing earlier-stage, more treatable cancers. The AWV effectively increases breast cancer screening and may lead to more timely screening. Continued investment in Annual Wellness Visits supports breast cancer screening completion by women who are most likely to benefit, thus reducing the risk of overscreening and overdiagnosis.

Impact of colorectal cancer screening on the incidence of advanced stages of the disease in the United States: An analysis of 181,442 patients.

10524 Background: Routine cancer screening, in addition to identifying early-stage cancers, aim to delay the time of diagnosis of the advanced stage. The impact of screening on the incidence of advanced colorectal cancer (aCC) in real-world settings is unknown. Methods: Data of adults aged 50–74 years with regional/distant stage (advanced) colorectal cancer diagnosed between 2004 and 2020 was obtained from the Surveillance, Epidemiology, and End Results Plus Data, 17 Research Plus Registries. The age-standardized incidence rates (ASIR) and annual percentage change (APC) were used to compare incidence trends stratified by sex, race/ethnicity, area of residence, and tumor site. Results: Among 181,442 cases of aCC, 56.6% were male, 117 847 (65%) were Non-Hispanic White (NHW), 23 419 (12.9%) were Non-Hispanic Black (NHB), 22 402 (12.4%) were Hispanics, 15 787 (8.7%) were Non-Hispanic Asian or Pacific Islander (NHAPI), 1564 (0.9%) were Non-Hispanic American Indian/Alaska Native (NHAIA), and 423 (0.2%) were of unknown race, respectively. In 123 609 cases (68.1%), the tumor site was in the colon, in the rectum in 41 395 cases (22.8%), and in the recto-sigmoid junction in 16 438 cases (9.1%). From 2004 to 2020, overall ASIR of aCC decreased (APC, -1.87%: -2.37 to -1.40), especially in females (APC, -2.05%: -2.53 to -1.55 vs. male: APC, -1.84%: -2.36 to -1.29), and metropolitan residents (APC, -2.01%: -2.57 to -1.43 vs. non-metropolitan: APC, -1.36%: -1.78 to -0.92). Notably, NHB showed the greatest decrease (APC, -2.56%: -3.01 to -2.06) followed by NHW (APC, -1.95%: -2.44 to -1.47), NHAPI (APC, -1.80%: -2.25 to -1.32) and Hispanics (APC, -1.29%: -1.85 to -0.64). There was no significant change in the ASIR among NHAIA. Furthermore, the ASIR of advanced colonic (APC, -2.66%: -3.18 to -2.14) and recto-sigmoid cancers (APC, -2.35%: -2.91 to -1.65) declined, but advanced rectal cancer increased (APC, 0.58%: 0.18 to 0.98) over the same period. Conclusions: This study highlights the positive impact of colorectal cancer screening in reducing aCC incidence rates in across genders, residential areas, and racial groups/ethnicities including minority populations. While there may be other contributing factors, increased awareness and use of screening may account for the overall declining aCC incidence rates over the almost 20-year study period. Further research is essential to identify factors contributing to the screening program's limited impact on the NHAIA population and advanced rectal cancers. [Table: see text]

Artificial intelligence as a second reader for screening mammography

Abstract Background Artificial intelligence (AI) has shown promise in mammography interpretation, and its use as a second reader in breast cancer screening may reduce the burden on health care systems. Purpose To evaluate the performance differences between routine double read and an AI as a second reader workflow (AISR), where the second reader is replaced with AI. Materials and Methods A cohort of patients undergoing routine breast cancer screening at a single center with mammography was retrospectively collected between 2005 and 2021. A model developed on US and UK data was fine-tuned on Japanese data. We subsequently performed a reader study with 10 qualified readers with varied experience (5 reader pairs), comparing routine double read to an AISR workflow. Results A “test set” of 4,059 women (mean age, 56 ± 14 years; 157 positive, 3,902 negative) was collected, with 278 (mean age 55 ± 13 years; 90 positive, 188 negative) evaluated for the reader study. We demonstrate an area under the curve =.84 (95% confidence interval [CI], 0.805-0.881) on the test set, with no significant difference to decisions made in clinical practice (P = .32). Compared with routine double reading, in the AISR arm, sensitivity improved by 7.6% (95% CI, 3.80-11.4; P = .00004) and specificity decreased 3.4% (1.42-5.43; P = .0016), with 71% (212/298) of scans no longer requiring input from a second reader. Variation in recall decision between reader pairs improved from a Cohen kappa of κ = .65 (96% CI, 0.61-0.68) to κ = .74 (96% CI, 0.71-0.77) in the AISR arm. Conclusion AISR improves sensitivity, reduces variability and decreases workload compared to routine dual screening.

AI-based diagnosis of chronic obstructive pulmonary disease from low-dose CT images

Background: Chronic obstructive pulmonary disease (COPD) is a group of diseases characterized by airflow blockage. It is one of the leading causes of global mortality and is primarily attributed to smoking. COPD patients are usually diagnosed by spirometry test. Although regarded as the gold standard for COPD diagnosis, the spirometry test carries contraindications, thus prompting the development of low-dose computed tomography (low-dose CT) scan as an alternative for COPD screening. However, a practical limitation of diagnosing COPD from CT images is its reliance on the expertise of a skilled radiologist. Objective: To address this limitation, we aimed to develop a deep-learning model for the automated classification of COPD and non-COPD from low-dose CT images. Materials and methods: We examined the potential of a convolutional neural network for identifying COPD. Our dataset consisted of 10,000 low-dose CT images obtained from a lung cancer screening program, involving both ex-smokers and current smokers deemed at high risk of lung cancer. Spirometry data served as the ground truth for defining COPD. We used 90% of the datasets for training and 10% for testing. Results: Our developed model achieved notable performance metrics: an area under the receiver operating characteristic curve (AUC) of 0.97, an accuracy of 0.89, a precision of 0.85, a recall of 0.96, and an F1-score of 0.90. Conclusion: Our study demonstrates the potential of deep learning models to augment clinical assessments and improve the diagnosis of COPD, thereby enhancing diagnostic accuracy and efficiency. The findings suggest the feasibility of integrating this technology into routine lung cancer screening programs for COPD detection.

Abstract PO5-07-06: Impact of patient-specific factors on quantitative breast parenchymal texture features

Abstract Breast parenchymal texture characterizes the spatial and structural patterns of breast tissue and is an independent predictor of breast cancer risk. Although it has conceptual similarities with another breast composition measure, breast density, parenchymal texture is more complex and is represented by multiple quantitative measures. The extent to which the epidemiology and biological basis of parenchymal texture and breast density differ has not been well described. In this cross-sectional study, we evaluated quantitative measures of parenchymal texture among 308 postmenopausal women aged ≥ 45 years who participated in a routine breast cancer screening at an academic medical center between 2020 and 2022. After providing informed consent, participants completed a short interview-based questionnaire. Additional demographic and breast cancer risk factor information was obtained from the medical record. Parenchymal texture features were measured from craniocaudal views of full-field digital mammograms. Measured texture values were standardized and averaged across left and right breasts. For this analysis, we evaluated associations between features previously validated as being associated with breast cancer risk (fractal dimension, grey-level mean, co-occurrence entropy and inverse difference moment) and patient personal and clinical characteristics reported at the time of screening. Associations between texture features and participant characteristics were evaluated using Pearson correlations (continuous variables) or the Kruskal-Wallis test (categorical variables). Generalized linear models were used to adjust for technical factors associated with image acquisition, including mammography machine, compression force, and software version. P-values less than 0.05 were considered statistically significant. Among the 308 participants, 70% were White, 24% were Black, 1% were Asian, 1% were American Indian, and 4% were another race that was not specified. 4% of participants reported Hispanic ethnicity. The mean age was 64.7 years (range 45 – 84 years). Fewer than half of the women were reported by a radiologist to have dense breasts (heterogeneously dense – 24%, extremely dense – 5%, vs. almost entirely fatty – 21%, scattered fibroglandular densities – 50%). The mean body mass index (BMI) was 29.4 kg/m2 (range 19.4 to 53.1 kg/m2) and 77% of the women were parous. BMI was strongly correlated with fractal dimension (r=0.62, P&amp;lt; 0.01) and grey-level mean (r=-0.48, P&amp;lt; 0.01), and had a weaker correlation with co-occurrence entropy (r=-0.19, P&amp;lt; 0.01). Age was weakly correlated with co-occurrence inverse difference moment (r=-0.12, P=0.03). BI-RADS breast density was inversely associated with fractal dimension, grey-level mean, and co-occurrence entropy (all P&amp;lt; 0.01). Adjustment for technical factors attenuated some associations, but BMI associations with fractal dimension (P&amp;lt; 0.01) and gray-level mean (P&amp;lt; 0.01), and breast density associations with fractal dimension, grey-level mean, and co-occurrence entropy (all P&amp;lt; 0.01) all remained statistically significant. Parity was not associated with any of the features evaluated in unadjusted or adjusted analyses (all P &amp;gt;0.05). These data suggest that, in postmenopausal women, risk-associated parenchymal texture features are associated with measures affected by body size and adiposity, but not with measures related to age or reproductive status. Longitudinal studies are needed to understand the temporality of these associations. Additionally, future studies will address the joint effects of texture features and the impact of endogenous estrogen levels on the features, which will provide insight into the biological mechanisms that influence texture feature associations with personal characteristics and breast cancer risk. Citation Format: Sarah Nyante, Yukie Kajita, Walter Mankowski, Ley Killeya, Despina Kontos, Xianming Tan, Eric Cohen, Cherie Kuzmiak. Impact of patient-specific factors on quantitative breast parenchymal texture features [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-07-06.

Welche Faktoren beeinflussen die Teilnahme am gesetzlichen Hautkrebsscreenings in Deutschland?

Due to increasing skin cancer incidence, Germany implemented a statutory nationwide routine skin cancer screening (rSCS) in 2008. The present study aims (1) to analyze which patient factors are associated with the participation in rSCS in Germany and (2) to investigate reasons for nonparticipation. Participants and nonparticipants of rSCS (≥35years) were recruited in routine care in nine dermatological outpatient clinics. Reasons for (non)participation, knowledge about skin cancer as well as clinical and socioeconomic data were obtained. Stratified by groups, descriptive analyses and binary logistic regression analyses for associations with participation were performed. Of the 294 rSCS participants and 162 nonparticipants, 46.5% were male with a mean age of 54.5 ±12.7years. In total, 87.1% had sunburns in childhood and 47.1% used sunbeds before. Higher age, female gender, previous sunbed use, and concern for and knowledge of skin cancer were significantly associated with previous rSCS participation. Of the nonparticipants, 46% were unaware of the option for free rSCS and 40% justified their nonparticipation on the basis of feeling healthy. The reasons for nonparticipation in rSCS, such as sociodemographic characteristics and risk behavior, should be known in order to optimize rSCS programs.

Which factors influence the participation in statutory skin cancer screenings in Germany?

Due to increasing skin cancer incidence, Germany implemented a statutory nationwide routine skin cancer screening (rSCS) in 2008. The present study aims (1) to analyze which patient factors are associated with the participation in rSCS in Germany and (2) to investigate reasons for nonparticipation. Participants and nonparticipants of rSCS (≥35years) were recruited in routine care in nine dermatological outpatient clinics. Reasons for (non-)participation, knowledge about skin cancer as well as clinical and socioeconomic data were obtained. Stratified by groups, descriptive analyses and binary logistic regression analyses for associations with participation were performed. Of the 294 rSCS participants and 162 non-participants, 46.5% were male with a mean age of 54.5 ±12.7years. In total, 87.1% had sunburns in childhood and 47.1% used sunbeds before. Higher age, female gender, previous sunbed use, and concern for and knowledge of skin cancer were significantly associated with previous rSCS participation. Of the non-participants, 46% were unaware of the option for free rSCS and 40% justified their nonparticipation on the basis of feeling healthy. The reasons for nonparticipation in rSCS, such as sociodemographic characteristics and risk behavior, should be known in order to optimize rSCS programs.

Does Neighborhood Social Cohesion Influence Participation in Routine Cancer Screening? Findings From a Representative Sample of Adults in South Florida.

Neighborhood social cohesion (NSC) has been associated with a variety of health outcomes, but limited research has examined its impact on behaviors that support cancer control. The purpose of this study was to examine associations between NSC and guideline-concordant breast, cervical and colorectal cancer screening. Data are from a cross-sectional survey administered to 716 adults in South Florida from 2019 to 2020. The analytic samples included adults eligible for breast (n = 134), cervical (n = 195), and colorectal cancer (n = 265) screening. NSC was measured using a validated 5-item instrument. Associations between NSC and guideline-concordant screening were examined using multivariable logistic regression. In fully adjusted analyses, the odds of guideline-concordant breast cancer screening increased by 86% for every unit increase in NSC (aOR = 1.86; 95% CI, 1.03-3.36). NSC was not statistically significantly associated with guideline-concordant cervical cancer screening (aOR = 0.86; 95% CI, 0.54-1.38) or colorectal cancer screening (aOR = 1.29; 95% CI, 0.81-2.04). These findings suggest that NSC supports some screening behaviors, namely, mammography use. To better understand heterogeneous relationships between NSC and utilization of preventive care services such as cancer screening, more research is needed that disaggregates effects by sex, age, race/ethnicity, and socioeconomic status.

Deep learning analysis of epicardial adipose tissue to predict cardiovascular risk in heavy smokers

BackgroundHeavy smokers are at increased risk for cardiovascular disease and may benefit from individualized risk quantification using routine lung cancer screening chest computed tomography. We investigated the prognostic value of deep learning-based automated epicardial adipose tissue quantification and compared it to established cardiovascular risk factors and coronary artery calcium.MethodsWe investigated the prognostic value of automated epicardial adipose tissue quantification in heavy smokers enrolled in the National Lung Screening Trial and followed for 12.3 (11.9–12.8) years. The epicardial adipose tissue was segmented and quantified on non-ECG-synchronized, non-contrast low-dose chest computed tomography scans using a validated deep-learning algorithm. Multivariable survival regression analyses were then utilized to determine the associations of epicardial adipose tissue volume and density with all-cause and cardiovascular mortality (myocardial infarction and stroke).ResultsHere we show in 24,090 adult heavy smokers (59% men; 61 ± 5 years) that epicardial adipose tissue volume and density are independently associated with all-cause (adjusted hazard ratios: 1.10 and 1.38; P < 0.001) and cardiovascular mortality (adjusted hazard ratios: 1.14 and 1.78; P < 0.001) beyond demographics, clinical risk factors, body habitus, level of education, and coronary artery calcium score.ConclusionsOur findings suggest that automated assessment of epicardial adipose tissue from low-dose lung cancer screening images offers prognostic value in heavy smokers, with potential implications for cardiovascular risk stratification in this high-risk population.