Routine Cancer Screening Research Articles

Perception of statutory skin cancer screening in the general population : Current findings on participation, knowledge and evaluation

Since 2008, German statutory health insurances offer routine skin cancer screening (rSCS) as astandard benefit. Insured persons aged 35years and older are eligible for screening every 2years. The aim of the study was to evaluate perception and utilization of rSCS in the general population. Arepresentative random sample of n= 1004 adult members of the German statutory health insurances were surveyed by the Forsa Institute via computer-assisted telephone interviews in across-sectional study in April 2015. On 39% of all persons interviewed, skin cancer screening had been executed at least once; the percentage of those entitled for rSCS was 45%. Of the participants, 50% were aware of the rSCS eligibility framework, with multiple sources of information. In 82% of cases, rSCS was performed by adermatologist. The majority (87%) of those who had already undergone rSCS stated that the advantages of the procedure outweighed inconveniences. While participation in rSCS constantly increased (2011-2013-2015), knowledge of eligibility did not. Seven years after implementation, rSCS has been utilized by almost half of those entitled and was rated positively by the majority. However, lack of knowledge about rSCS eligibility is also present in 50%. Further targeted informative measures are needed to increase awareness of rSCS.

Increasing Cancer Screening Among Old Order Anabaptist Women Through Specialized Women’s Health and Integrated Cancer Screening Interventions

Our objective was to develop, deliver, and evaluate a cancer screening intervention focused on rural Anabaptist communities in Ontario, Canada, to increase routine cancer screenings among women. We carried out three cancer prevention and screening interventions with Old Order Anabaptist women. Each intervention consisted of: transportation to the site, pre-arranged screening services, health teachings, fellowship and shopping, and an evaluative survey. Seventy five womentotal participated over three interventions. 85% of participants were under or never screened for cancer. This was the first breast screen for 26% of those who completed a mammogram and the first colon screen for 29% of the women who took home an FOBT collection kit. Reviews of the intervention were positive. Integration and community based planning were the primary reasons for the success of this cancer screening intervention. Intervention days were best timed in the early spring before planting or late fall after canning.

Incidence of interval cancers in faecal immunochemical test colorectal screening programmes in Italy.

Objective In Italy, colorectal screening programmes using the faecal immunochemical test from ages 50 to 69 every two years have been in place since 2005. We aimed to measure the incidence of interval cancers in the two years after a negative faecal immunochemical test, and compare this with the pre-screening incidence of colorectal cancer. Methods Using data on colorectal cancers diagnosed in Italy from 2000 to 2008 collected by cancer registries in areas with active screening programmes, we identified cases that occurred within 24 months of negative screening tests. We used the number of tests with a negative result as a denominator, grouped by age and sex. Proportional incidence was calculated for the first and second year after screening. Results Among 579,176 and 226,738 persons with negative test results followed up at 12 and 24 months, respectively, we identified 100 interval cancers in the first year and 70 in the second year. The proportional incidence was 13% (95% confidence interval 10-15) and 23% (95% confidence interval 18-25), respectively. The estimate for the two-year incidence is 18%, which was slightly higher in females (22%; 95% confidence interval 17-26), and for proximal colon (22%; 95% confidence interval 16-28). Conclusion The incidence of interval cancers in the two years after a negative faecal immunochemical test in routine population-based colorectal cancer screening was less than one-fifth of the expected incidence. This is direct evidence that the faecal immunochemical test-based screening programme protocol has high sensitivity forcancers that will become symptomatic.

Incidence of Non-Melanoma Skin Cancer in the Uninsured.

Non-melanoma skin cancer (NMSC) is a common reason for outpatient primary care visits. Uninsured patients may be at a higher risk for NMSC due to lack of access to health care and a possible increased risk of sun exposure due to insecure housing. The true incidence of NMSC in this population is unknown. In order to determine the population's incidence of NMSC we performed a retrospective chart review on all patients (n = 656) seen at the Lubbock Impact Free Clinic from July 1, 2014 through July 30, 2015. This highlighted an increased incidence of NMSC in our uninsured population (1.4% [9/656]), particularly in the 50-64 age range (2.8% [7/250]) when compared with the general United States population (0.65%-1.05%). We believe that skin care education and routine skin cancer screening should be emphasized in the care of these patients due to their increased risk.

Skin Cancers Among Chronic Lymphocytic Leukemia (CLL) Patients - the Effect of UV Radiation and CLL Clinical Characteristics

Background: It is well established that the incidence of skin cancers in patients with CLL are significantly elevated compared to age- and sex- matched controls. However, little is known about the characteristics of CLL patients who develop skin cancer. Herein, we evaluate the associations of CLL clinical and prognostic characteristics, along with UV radiation exposure, with risk of first skin cancer following CLL diagnosis.Methods: Newly diagnosed CLL patients from Minnesota, Iowa, and Wisconsin were enrolled in the Mayo Clinic case-control study from 2002-2015 and systematically followed in the Iowa/Mayo Lymphoma SPORE. Clinical and prognostic CLL data were obtained from the Mayo Clinic CLL database, and skin cancer clinical data were abstracted from medical records using a standard protocol. The CLL international prognostic index (CLL-IPI) was computed using a weighted average of five independent CLL prognostic factors (IGHV mutational status, serum b2-microglobulin, Rai stage, age, and FISH 17p deletion/TP53 status). Self-reported history of midday sun exposure at various ages (birth to age 12; 13 to 21 years; 22 to 40 years, and 41+ years) was obtained from a risk factor questionnaire. For each age, we asked the extent of mid-day sun as: practically no exposure (under 3 hours per week), little exposure (4-7 hours per week), moderate exposure (8 to 14 hours per week) and extensive exposure (15+ hours per week). Midday sun exposure was modeled as an ordinal covariate. To evaluate associations with risk of skin cancer following CLL diagnosis, we calculated time from date of CLL diagnosis to date of first skin cancer, death, or last known follow-up. We used Cox regression analysis to estimate hazard ratios (HRs) and 95% CIs. CLL treatment was considered a time-dependent covariate.Results: Among 846 CLL patients enrolled, the median age at diagnosis was 63 years (range 28-91), 68% were male, 7% had Rai stage III-IV at diagnosis. Based on the CLL-IPI, 42% were categorized as low risk, 33% as intermediate risk, and 25% as high or very-high risk. 109 CLL cases (13%) had one or more reported skin cancers at or prior to CLL diagnosis. Melanoma was observed in 19 (2%) cases and non-melanoma was in 90 (11%) cases. At a median follow-up of 7 years from CLL diagnosis, 165 patients (20%) had one or more skin cancers after CLL diagnosis. Among these patients, 49 had skin cancer before CLL diagnosis. The most frequent skin cancer was squamous cell carcinoma (59%), followed by basal cell (31%), melanoma (5%), and Merkel cell (1%). 552 (65%) of the 846 patients returned a questionnaire. Significant associations of clinical and prognostic characteristics with risk of first skin cancer were observed for age (HR=1.35 per 10 year increase, 95% CI=1.17-1.56, P<0.001), male sex (HR=1.38, 95% CI 0.98-1.96, p=0.07), prior history of skin cancer (HR=4.19, 95% CI=2.98-5.88, P<0.001), and CLL-IPI (HR=1.26, 95% CI= 1.03-1.54, P=0.026, after adjusting for age, sex, and prior skin cancer). Of note, the risk of first skin cancer in those CLL patients categorized as very high via CLL-IPI had 2.28 fold risk (95% CI 1.02-5.11). Midday sun exposures for each of the ages considered showed no evidence of association with risk of first skin cancer (all P>0.05). 50 CLL patients were treated prior to first skin cancer following CLL diagnosis; we observed no evidence of association between treatment and risk of first skin cancer (HR=1.44, 95% CI= 0.93-1.92, P=0.12).Conclusion: CLL patients who are at an increased risk of skin cancer following CLL diagnosis are those who either have had a prior history of skin cancer or a more aggressive CLL disease at diagnosis, according to CLL IPI. Routine skin cancer screening is currently recommended for CLL patients. Our data suggest that more frequent screening would be particularly important among patients with aggressive CLL and who have a prior history of skin cancer. Unexpectedly, we found no evidence of association of skin cancer risk with UV radiation following CLL diagnosis or with CLL treatment. Further investigation is needed to determine whether other factors increase the risk of skin cancer following CLL diagnosis. DisclosuresShanafelt:Genentech: Research Funding; GlaxoSmithkKine: Research Funding; Janssen: Research Funding; Celgene: Research Funding; Cephalon: Research Funding; Pharmacyclics: Research Funding; Hospira: Research Funding.

Cancer Risk Factor Knowledge Among Young Adults.

Cancer is the second leading cause of death in the USA. Incidence and mortality rates for cancer have risen steadily and cost the healthcare system over $264 billion annually. Cancer risk can be reduced by restricting alcohol consumption, avoiding tobacco, eating a balanced diet, limiting sun exposure, exercising, and seeking routine cancer screenings. The purpose of this study is to examine cancer risk factor knowledge among college students. Researchers surveyed undergraduate and graduate students (n=758) at a mid-sized public university in the Southeast about their knowledge regarding cancer risk factors including smoking, alcohol consumption, diet, obesity, hypertension, and human papillomavirus (HPV). Participants were mostly able to identify the association between cancers and health risk behaviors that have received widespread media coverage, are somewhat intuitive, or are salient to their life stage such as drinking, tanning, and smoking. Nearly all participants correctly reported exposure to ultraviolet (UV) rays, and smoking increased risk of developing skin and lung cancer, respectively. Most students correctly identified an increased risk of liver cancer associated with alcohol use but missed head/neck and breast cancer. However, knowledge of less publicized relationships was insufficient. The findings offer encouragement to public health professionals that campaigns have increased awareness of cancer risk. However, there were many relationships that revealed a lack of knowledge, and future campaigns can target lesser-known cancer risk relationships to reduce the personal tragedy and societal burden of cancer.

Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial

BackgroundThe UK Lung Cancer Screening (UKLS) trial is a randomised pilot trial of low-dose CT (LDCT) screening for individuals at high risk of lung cancer. We assessed the long-term psychosocial...

TH-AB-209-06: An Investigation of the Feasibility of Malignant Lesion Detection During Routine Breast Cancer Screening Using a Prototype Acousto-Optic Transmission Ultrasound Imaging System

Purpose: To investigate the feasibility of malignant lesion detection during routine breast cancer screening using an acousto-optic (AO) transmission ultrasound imaging system, particularly in premenopausal women with high breast density. Methods: A full-field, single-projection ultrasound imaging system was developed that uses a high-resolution AO detector to convert the acoustic intensity transmitted through the compressed breast into a visual image by virtue of the AO effect in nematic liquid crystals. In this work, a comprehensive system model was proposed to describe the AO imaging process, including the generation of the incident acoustic field by the transducer, the propagation of the field through the breast tissue, and the conversion of the transmitted acoustic field intensity into a visual image. Validation of the imaging model was achieved through comparison of actual AO breast phantom images with simulated images based on the proposed model. Malignant lesion detectability studies were subsequently performed in simulation using homogeneous and heterogeneous numerical breast phantoms. Results: Comparison of actual AO breast phantom images with simulated images based on the proposed system model showed strong agreement, with an RMSE less than 4%. Lesion detectability studies using homogeneous numerical breast phantoms demonstrated excellent visibility for breast lesions as small as 0.5 cm and source frequencies on the order of 4 MHz. Though lesion detectability proved immune to spatial variations in mass density (2%) and attenuation (15%) in the breast parenchyma, minor variations in parenchymal sound speed (1.3%) resulted in substantial refraction artifacts that compromised the diagnostic utility of the prototype system. Conclusions: Differences in acoustic absorption may overcome refraction and enhance lesion visibility at conventional breast ultrasound frequencies (10 to 15 MHz). However, provided the FDA limit on the incident acoustic intensity (1 W/cm2) is employed, such high-frequency imaging will require improvements in the current AO detector sensitivity (10−6 W/cm2). Department of Defense (DOD) Breast Cancer Research Program IDEA Award W81XWH-11-1-0332; National Institutes of Health (NIH) Grant T32 EB002103-24 from the National Institute of Biomedical Imaging and Bioengineering (NIBIB)

132 Reason for referral to dermatologic care and non-melanoma skin cancer diagnoses in solid organ transplant recipients

Solid organ transplant recipients (SOTRs) have a 100-fold increased risk for non-melanoma skin cancer (NMSC); early detection is a critical part of their management. We sought to determine how the reasons for which SOTRs are referred to dermatologic care by non-dermatologic providers might correlate with subsequent NMSC diagnoses. A total of 353 SOTRs referred to a specialized transplant dermatology clinic between 2007 and 2012 were examined in this nested case-control study. Eighty-one SOTRs with 491 lesions—192 actinic keratoses (AK), 106 basal cell carcinomas, and 193 squamous cell carcinomas—were compared with 272 SOTRs who did not develop any AKs or NMSCs within the study follow-up period. Of the SOTRs diagnosed with AK or NMSC within 6 months after their first dermatologic visit, 33% had been referred by non-dermatologic providers for “lesion of concern/skin cancer,” while 22% SOTRs were originally referred for “rash/acne.” Of the SOTRs who developed invasive NMSCs in the 6-year follow-up period, 27% had been referred for “lesion of concern/skin cancer,” while 34% were originally referred for “rash/acne.” These results indicate that, despite the well-established heightened risk of NMSCs in SOTRs and care delivered in a multidisciplinary transplant clinic within a tertiary care center, a significant fraction of SOTRs who are referred to dermatologic care for benign skin disorders is still being incidentally diagnosed with cutaneous malignancies; this is especially concerning given that a referral for a benign skin condition could delay appropriate diagnosis and treatment of cutaneous malignancies, as well as SOTR risk-specific photo-education, prevention, and surveillance. Better risk stratification, improved interdisciplinary collaboration, prompt referral for routine skin cancer screening, and more timely referrals for suspicious lesions are needed in the care of SOTRs.

Trends in colorectal cancer screening over time for persons with and without chronic disability

BackgroundPersons with disabilities have often experienced disparities in routine cancer screening. However, with civil rights protections from the 1990 Americans with Disabilities Act, such disparities may diminish over time. ObjectiveTo examine whether disability disparities exist for colorectal cancer screening and whether these screening patterns have changed over time. MethodsWe analyzed National Health Interview Survey responses from civilian, non-institutionalized U.S. residents 50–75 years old from selected years between 1998 and 2010. We specified 7 chronic disability indicators using self-reported functional impairments, activity/participation limitations, and expected duration. Separately for women and men, we conducted bivariable and multivariable logistic regression analyses examining associations of self-reported colorectal cancer screening services with sociodemographic factors and disability type. ResultsPatterns of chronic disability differed somewhat between women and men; disability rates generally rose over time. For both women and men, colorectal cancer screening rates increased substantially from 1998 through 2010. Over time, relatively few statistically significant differences were reported in colorectal cancer screening rates between nondisabled persons and individuals with various disabilities. In 2010, reported screening rates were generally comparable between nondisabled and disabled persons. In the few statistically significant differences, persons with disabilities almost always reported higher colorectal cancer screening rates than nondisabled individuals. ConclusionsAccording to national survey data, reported use of colorectal cancer screening is similar between nondisabled persons and individuals with a variety of different disability types. Despite physical demands of some colorectal cancer screening tests, disparities do not appear between populations with and without disability.

Case Report: Rectal perforation during CT colonography.

Introduction Computer tomography colonoscopy (CTC) is an increasingly prevalent procedure for the investigation of colorectal symptoms, or as a component of colorectal cancer screening. It is considered a low risk procedure, however colonic perforation is a recognized significant complication. Case Report We report the case of an 81-year-old female patient who underwent CTC after failed optical colonoscopy as part of routine colorectal cancer screening. Perforation of the rectum with surrounding pararectal air was confirmed on CTC. The patient had minimal symptoms and was treated successful non-operatively with bowel rest and antibiotics. Conclusion Perforation sustained during CTC is an uncommon complication. The incidence of perforation during CTC is still lower than that during optical colonoscopy. In the absence of significant abdominal signs and symptoms, this rare complication may be successfully managed non-operatively.

Abstract P1-09-06: The effect of Hispanic nativity and ethnicity on mammography use through the Avon breast health outreach program

Abstract Introduction Although Hispanic women have lower rates of breast cancer compared to non-Hispanic whites (NHW), breast cancer remains the leading cause of cancer death among Hispanic women . Some studies suggest that Hispanic women have lower rates of breast cancer screening compared to NHW women, primarily due to lack of health insurance and socioeconomic disadvantages . This study aims to understand the demographic characteristics of Hispanic women in the U.S. who access and utilize the Avon Breast Health Outreach Program (BHOP), and how Hispanic women's mammography history differs by nativity. Avon BHOP supports community-based organizations to conduct education and outreach to over 50,000 low-income and uninsured women each year, linking them to routine breast cancer screening and care. Methods This study analyzed 2014 Client Intake Forms (CIF) for all women aged 40 and older, who were served by BHOP for the first time (∼16,000 women). Descriptive analysis was conducted to summarize their demographic and breast health information, comparing Hispanics with NHW. Multivariate logistic regression was performed to examine the relationship between ethnicity and nativity and having a mammogram in the last two years. Lastly, a sub-analysis among foreign-born (FB) Hispanics only was conducted to assess how the length of time living in the U.S. (number of years) impacts the likelihood of having a mammogram in the last two years. Results Of the first time clients served through BHOP in 2014, 10.4% were US-born Hispanics, 45.2% were FB-Hispanics, and 44.4% were NHW. The majority of FB-Hispanic women were from Mexico (66.2%). FB-Hispanics are less likely to have insurance as compared to US-born Hispanic women (19.7% vs. 39.3%), and less likely to have a high school degree (34.3% vs. 44.8%). After controlling for demographic and socioeconomic variables, FB-Hispanics had significantly greater odds of having a mammogram in the past two years compared to US-born Hispanics (OR=1.6, 95% CI, 1.3-1.9), and NHW women (OR=1.4, 95% CI, 1.2-1.6). FB-Hispanics living in the U.S. for 5+ years had a 1.7 greater odds of having a mammogram in the past 2 years, as compared to recent immigrants living in the U.S. for less than one year (OR=1.7 ;95% CI, 1.1 – 2.7). Discussion In 2014, the percentage of BHOP Hispanic women aged 40+, reporting a mammogram in the last two years (41.1%) was lower than the overall U.S. Hispanic rate (61.4%) , suggesting confirmation that BHOP serves vulnerable and underserved populations, as it aims to do. This study also demonstrates how screening behaviors differ among Hispanic women served through BHOP, with FB-Hispanics having higher mammography utilization rates as compared to their US-born counterparts, with variation seen by the number of years living in the U.S. In conclusion, it is critical to view Hispanics as a heterogeneous group in order to best address their clinical needs. Specifically, the results point to how U.S.-born Hispanic BHOP clients may be at particularly high risk for low breast cancer screening. Citation Format: Gates-Ferris K, Senter L, Aliaga M, Hurlbert M, Ricci C. The effect of Hispanic nativity and ethnicity on mammography use through the Avon breast health outreach program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-06.

Trends in United States Prostate Cancer Incidence Rates by Age and Stage, 1995-2012.

The advent of PSA testing in the late 1980s substantially increased prostate cancer incidence rates. Concerns about overscreening and overdiagnosis subsequently led professional guidelines (circa 2000 and later) to recommend against routine PSA testing. We evaluated trends in prostate cancer incidence, including late-stage diagnoses, from 1995 through 2012. We used joinpoint regression analyses to evaluate all-, localized/regional-, and distant-stage prostate cancer incidence trends based on Surveillance, Epidemiology, and End Results (SEER) data. We stratified analyses by age (50-69, 70+). We reported incidence trends as annual percent change (APC). Overall age-adjusted incidence rates for localized/regional stage prostate cancer have been declining since 2001, sharply from 2010 to 2012 [APC, -13.1; 95% confidence intervals (CI), -23.5 to -1.3]. Distant-stage incidence rates have declined since 1995, with greater declines from 1995 to 1997 (APC, -8.4; 95% CI, -2.3 to -14.1) than from 2003 to 2012 (APC, -1.0; 95% CI, -1.7 to -0.4). Distant-stage incidence rates declined for men ages 70+ from 1995 to 2012, but increased in men ages 50 to 69 years from 2004 to 2012 (APC, 1.7; 95% CI, 0.2 to 3.2). Guidelines discouraging routine prostate cancer screening were temporally associated with declining localized/regional prostate cancer incidence rates; however, incidence rates of distant-stage disease are now increasing in younger men. This trend may adversely affect prostate cancer mortality rates.

Introducing Digital Mammography in a Resource Constrained Setting: Spectrum of Imaging Findings and Diagnostic Value in Ado-Ekiti, South Western Nigeria

Early diagnosis and treatment achieved through Mammographic screening plays a key role in the reduction of breast related morbidities and mortalities in middle and low income countries. This study highlights the spectrum of digital mammography findings in a tertiary health institution in Ado-Ekiti, South western Nigeria. A cross-sectional descriptive study of clients who presented for digital mammography at a newly equipped hospital was conducted within a year. The mammograms were reviewed by two radiologists and overall imaging findings were classified using the American College of Radiology Breast Imaging Reporting and Data System (ACR-BIRADS). Data analysis was done using SPSS version 20.0. A total of 154 clients with age range of 37 to 85 years (mean age of 51± 9.6years) underwent mammography during the study period. There was one male and 153 females out of which 69(45.1%) were postmenopausal while 84(54.9%) were premenopausal. Major clinical indications for mammography included routine breast cancer screening (N= 59, 38.3%), breast lump (N= 43, 27.9%) and breast pain (N=34, 22.1%). Mammograms were normal in 37(24.0%), inconclusive in 51(33.1%) and abnormal in 66(42.9%) clients. Abnormal mammographic findings included various forms of calcifications (N=56, 36.4%), breast opacities/masses (N=42, 27.3%), axillary lymphadenopathy (N=14, 9.0%), focal glandular asymmetry (N=10, 6.5%) and architectural distortion (N=6, 3.9%). About 55(35.7%) patients underwent additional imaging with ultrasonography, out of which 32(58.2%) had positive sonographic findings. The use of ultrasonography for additional imaging in cases of inconclusive mammograms improves the diagnostic yield. A greater proportion of the clients had mammography done for diagnostic reasons rather than screening purposes. Hence there is the need for increased awareness of screening mammography among the women in resource constrained settings.

Associations Between Women's Perception of Their Husbands'/Partners' Social Support and Pap Screening in Pacific Islander Communities.

Pacific Islanders experience high rates of cervical cancer incidence and mortality. This cross-sectional study examined the extent to which Samoan, Chamorro, and Tongan women's perceived receipt of social support from their husbands or male partners was associated with rates of routine cancer screening- specifically Pap testing. A total of 585 Pacific Islander women who live in the United States completed a self-report survey. Women who reported having a Pap test within the past 3 years had significantly higher scores on support from their husbands/male partners. Furthermore, the relationship of emotional support and informational support with increased Pap testing was significantly stronger for Tongan women. The findings suggest that men play an important role in promoting women's cancer prevention behaviors in Pacific Islander and potentially other collectivistic populations. Incorporating social support messages into interventions may be a simple yet effective strategy to increase women's Pap testing.

Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.

To provide updates for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines on human papillomavirus (HPV) and anogenital warts (AGWs), a review of the literature was conducted in key topic areas: (1) epidemiology and burden of disease; (2) transmission and natural history; (3) diagnosis and management of AGWs; (4) occupational exposure of healthcare workers; (5) anal cancer screening among men who have sex with men (MSM); and (6) HPV vaccine recommendations. Most sexually active persons will have detectable HPV at least once in their lifetime; 14 million persons are infected annually, and 79 million persons have prevalent infection. HPV is transmitted frequently between partners; more frequent transmission has been reported from females to males than from males to females. A new formulation of imiquimod (3.75% cream) is recommended for AGW treatment. Appropriate infection control, including performing laser or electrocautery in ventilated rooms using standard precautions, is recommended to prevent possible transmission to healthcare workers who treat anogenital warts, oral warts, and anogenital intraepithelial neoplasias (eg, cervical intraepithelial neoplasia). Data are insufficient to recommend routine anal cancer screening with anal cytology in persons living with human immunodeficiency virus (HIV)/AIDS or HIV-negative MSM. An annual digital anorectal examination may be useful for early detection of anal cancer in these populations. HPV vaccine is recommended routinely for 11- or 12-year-olds, as well as for young men through age 21 years and young women through age 26 years who have not previously been vaccinated. HPV vaccine is also recommended for MSM, people living with HIV/AIDS, and immunocompromised persons through age 26 years.

Abstract 16624: Lung Cancer Screening With CT, Coronary Artery Calcification and Cardiovascular Events

Background: The Centers for Medicare &amp; Medicaid Services (CMS) recently approved lung cancer screening with CT. It is unclear whether reporting coronary artery calcium (CAC) on lung screening CT could improve identification of adults at risk for cardiovascular events (CVD) and competing risk from lung cancer. Thus we determined the incidence of hard CVD (myocardial infarction, stroke or coronary/cerebrovascular death), lung cancer (diagnosis or death) and CAC in adults eligible and ineligible for lung cancer screening. Methods: This longitudinal community-based cohort study included Framingham Heart Study Offspring Cohort participant-exams age 55-77 and free of prevalent cardiovascular disease and lung cancer from exams 3 (1984 – 1987) and 7 (1998 – 2001). Participants were divided into screening eligible and ineligible groups by CMS criteria (current or recent (≤15 years) former smokers with ≥30 pack-year history). Multivariate-adjusted cox proportional hazards models assessed the effect of screening eligibility on incident hard CVD and incident lung cancer. In participants who had CAC CT at exam 7, cross-sectional association between screening eligibility, high CAC score &gt;300 and incident CVD was assessed. Raw incidence rates are reported; p values are adjusted for age, sex and traditional risk factors aside from smoking. Results: Of 3085 participant-exams 20% were eligible for lung cancer screening. In mean follow up of 9.9 years, there were 281 incident CVD and 69 lung cancer events. In both groups, incident CVD was more frequent than lung cancer (eligible: 13% vs 7%, p=0.002; ineligible: 8% vs 1%, p&lt;0.001). The screening eligible had more incident CVD (13% vs 8%, p&lt;0.001) and lung cancer (7% vs 1%, p&lt;0.001) than the ineligible. CAC CT was available in 107 screening eligible and 667 ineligible participants; CAC &gt;300 was more common in the screening eligible (33% vs 23%, p=0.007). Conclusion: In a community-based primary prevention cohort, 20% aged 55-77 were eligible for lung cancer screening CT. CMS eligibility criteria identified disease-free persons with substantially more incident hard CVD and CAC; CVD was more common than lung cancer. The results support cardiovascular prevention and reporting of CAC as part of routine lung cancer screening CT.

Family physicians' intention to support women in making informed decisions about breast cancer screening with mammography: a cross-sectional survey.

BackgroundThe net benefits of routine breast cancer screening with mammography have been questioned, and there is evidence to indicate that supporting women to make an informed decision about breast cancer screening with mammography is preferable. The aims of this study were to assess the intention of family physicians to provide women with this support and the determinants of this intention, and to identify factors that might influence family physicians adopting this behavior.MethodsFamily physicians from the province of Quebec, Canada, attending a 45-min lecture on informed decision making and cancer screening were asked to complete a questionnaire after the lecture regarding their intention to adopt the behavior. The questions, based on the Theory of Planned Behavior, measured physicians’ intention and its determinants (attitude, perceived behavioral control, and socio-professional norm) regarding supporting women to make informed decisions about breast cancer screening with mammography. Open-ended questions were also used to explore complementary factors influencing their intention.ResultsOut of 800 questionnaires distributed, 301 (38 %) were returned and 288 were included in data analysis. The mean ± standard deviation and median score for intention were respectively 1.9 ± 1.2 and 2.0 on a 6-point Likert scale (−3 to +3). Perceived behavioral control was the variable most strongly associated with intention (high versus low score, odds ratio = 15.7, 95 % CI 6.7–36.6), followed by attitude (high versus low score, odds ratio = 7.5, 95 % CI 3.3–16.8), then social norm (high versus low score, odds ratio = 5.8, 95 % CI 2.6–12.9). The most-reported barrier to adopting the behavior was time constraints (41 %) while the most-reported facilitator was availability of relevant decision support tools (29 %).ConclusionsRespondents showed strong intention to support women in informed decision-making about breast cancer screening, the strongest predictor being perceived behavioral control. These results could contribute to training physicians to integrate this behavior into their practices and to designing relevant decision support tools.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1608-8) contains supplementary material, which is available to authorized users.

Rectal cancer in patients under the age of 50 years: the delayed diagnosis

BackgroundThe incidence of rectal cancer in younger patients continues to increase. Because most of these patients do not meet criteria for routine colorectal cancer screening, diagnosis may be delayed, potentially resulting in adverse outcomes. The aim of this study was to determine whether patients under the age of 50 years with rectal cancer have a delay in diagnosis and treatment leading to a worse overall prognosis. MethodsA case control study of patients diagnosed with rectal adenocarcinoma in an academic medical center from 1997 to 2007 under 50 years of age were matched 1:1 to randomly selected patients over the age of 50 years by sex and date of diagnosis. Time to diagnosis, time to treatment, staging of the American Joint Committee on Cancer, and 5-year overall survival were compared. ResultsThe overall time to treatment from symptom onset was 217 days for patients under the age of 50 years versus 29.5 days if over 50 years of age (P < .0001). The primary delay occurred between the onset of symptoms and presentation to the initial physician. There was no difference in stage at the time of diagnosis or 5-year survival (64% vs 71%, P = .39 and P = .54, respectively). ConclusionsPatients with rectal cancer under the age of 50 years have symptoms for a considerable period of time before seeking medical care and are referred in less timely manner to specialists. However, the delay in diagnosis did not adversely impact stage on presentation or 5-year survival.

Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services.

BackgroundIn Malawi, routine breast cancer screening is not available and little is known about women’s preferences regarding early detection services. Discrete choice experiments are increasingly used to reveal preferences about new health services; however, selecting appropriate attributes that describe a new health service is imperative to ensure validity of the choice experiment.ObjectiveTo identify important factors that are relevant to Malawian women’s preferences for breast cancer detection services and to select attributes and levels for a discrete choice experiment in a setting where both breast cancer early detection and choice experiments are rare.MethodsWe reviewed the literature to establish an initial list of potential attributes and levels for a discrete choice experiment and conducted qualitative interviews with health workers and community women to explore relevant local factors affecting decisions to use cancer detection services. We tested the design through cognitive interviews and refined the levels, descriptions, and designs.ResultsThemes that emerged from interviews provided critical information about breast cancer detection services, specifically, that breast cancer interventions should be integrated into other health services because asymptomatic screening may not be practical as an individual service. Based on participants’ responses, the final attributes of the choice experiment included travel time, health encounter, health worker type and sex, and breast cancer early detection strategy. Cognitive testing confirmed the acceptability of the final attributes, comprehension of choice tasks, and women’s abilities to make trade-offs.ConclusionApplying a discrete choice experiment for breast cancer early detection was feasible with appropriate tailoring for a low-income, low-literacy African setting.