Screening Options Research Articles

Clinical Presentation and VRT-CT Features in Pediatric Patients with COVID-19 Infection

Objective: The aim of this study is to discuss the clinical, laboratory, chest computed tomography (CT) and volumetric imaging technique (VRT) features in pediatric patients with novel coronavirus 2019 (COVID-19) infection. Material and Methods: The clinical, laboratory, and chest CT features of 17 pediatric patients with COVID?19 infection those confirmed by pharyngeal swab COVID?19 polymerase chain reaction(PCR) were evaulated. All clinical and laboratory data have been recorded and analyzed during march-february 2021 . Chest CT have been performed to all Covid 19 PCR confirmed patients and radiologicall view have been noted. Results: Seventeen pediatric patients with a history of close contact with COVID?19 diagnosed family members included to the study. Fever (10/17, 58%) and cough (13/17, 76%) were the most common symptoms. For laboratory findings, c reactive protein elevation (15/17, 88%) seem to be the most finding. A total of 4 patients presented with unilateral pulmonary lesions (4/17, 23%), 9 with bilateral pulmonary lesions (9/17, 52%) and 13 cases showed bilateral diffuse covid pattern on chest CT (13/17, 76%). Non-spesific consolidation with was observed in 8 patients (8/17, 47%), ground?glass opacities were observed in 11 patients (11/17, 64%), nodules were observed in 7 patients (7/17, 41%), and tiny nodules were observed in 2 patients (2/17, 11%). Conclusion: In pediatric patients before confimation positivitiy of COVID?19 nucleic acid test from pharyngeal swab samples; the early detection of lesions with chest CT especialy by VRT (volumetric rendering technique)-CT tecnique can be efficient; in management and early treatment for pediatric patients. More clinical trails can suggest about the primeline screening and treatment options in pediatric covid-19 infection in future.

Breast cancer recurrence: factors impacting occurrence and survival

BackgroundBreast cancer mortality has decreased due to improved screening and treatment options. Nevertheless, 25–30% of patients develop disease recurrence and die from the disease dissemination. Patients who develop metastatic disease represent a heterogeneous group and management plans are dependent on molecular subtype, disease burden and metastatic site.AimTo determine predictive clinicopathological factors of disease recurrence and their impact on survival in the molecular era.MethodsConsecutive patients who breast cancer developed recurrence at our tertiary referral centre between 2000 and 2015 were included. Clinicopathological and treatment data were assessed using descriptive statistics. Oncological outcome was assessed using Cox regression and Kaplan Meier analyses.ResultsTwo hundred sixty-five consecutive patients who developed breast cancer recurrence were included; median age at metastasis was 59.3 years (range 27–87 years), and median time to recurrence (TTR) was 47.7 ± 38.5 months (range 3.0–194.3 months). Survival was 24.2% (64/265) 53.2% were luminal A (LABC) (141/265), 18.5% were luminal B (LBBC) (49/265), 18.5% were triple negative (TNBC) (49/265), and 9.8% were human epidermal growth factor receptor-2 overexpressing (HER2 +) (26/265). TTR for patients with LABC was 56.0 ± 41.3 months, LBBC was 48.4 ± 41.1 months, TNBC was 26.9 ± 28.5 months and HER2 + was 34.3 ± 21.8 months. Increased grade (P < 0.001), Nottingham Prognostic Indices (P < 0.001), TNBC (P < 0.001), HER2 + subtype (P < 0.001) and receiving targeted therapy (P = 0.006) predicted shorted TTR. Estrogen receptor positivity (P < 0.001), progesterone receptor positivity (P = 0.010), invasive lobular carcinoma (P = 0.009) and receiving endocrine therapy (P = 0.001) predicted longer TTR.ConclusionReadily available clinicopathological factors predict risk of metastatic dissemination. Developing a tailored program to identify patients at risk of recurrence is crucial in controlling metastatic dissemination of breast cancer.

A Procedure for Eliciting Women's Preferences for Breast Cancer Screening Frequency.

BackgroundWe evaluate the construct validity of a proposed procedure for eliciting lay preferences among health care policy options, suited for structured surveys. It is illustrated with breast cancer screening, a domain in which people may have heterogeneous preferences.MethodsOur procedure applies behavioral decision research principles to eliciting preferences among policy options expressed in quantitative terms. Three-hundred women older than 18 y without a history of breast cancer were recruited through Amazon MTurk. Participants evaluated 4 screening options for each of 4 groups of women, with varying risk of breast cancer. Each option was characterized by estimates of 3 primary outcomes: breast cancer deaths, false alarms, and overdiagnosis resulting in unnecessary treatment of cancers that would not progress. These estimates were based on those currently being developed by the Breast Cancer Surveillance Consortium. For each risk group, participants stated how frequently they would wish to receive screening, if the predicted outcomes applied to them.ResultsA preregistered test found that preferences were robust enough to be unaffected by the order of introducing and displaying the outcomes. Other tests of construct validity also suggested that respondents generally understood the task and expressed consistent preferences. Those preferences were related to participants’ age and mammography history but not to measures of their numeracy, subjective numeracy, or demographics. There was considerable heterogeneity in their preferences.ConclusionsMembers of the public can be engaged more fully in informing future screening guidelines if they evaluate the screening options characterized by the expected health outcomes expressed in quantitative terms. We offer and evaluate such a procedure, in terms of its construct validity with a diverse sample of women.HighlightsA novel survey method for eliciting lay preferences for breast cancer screening is proposed and evaluated in terms of its construct validity.Participants were generally insensitive to irrelevant task features (e.g., order of presentation) and sensitive to relevant ones (e.g., quantitative estimates of breast cancer risk, harms from screening).The proposed method elicits lay preferences in terms that can inform future screening guidelines, potentially improving communication between the public and policy makers.

P673 Trends in inflammatory bowel disease infections and vaccinations in the past four decades - a high-level text mining analysis of PubMed publications

BackgroundMany therapeutic options for inflammatory bowel disease emerged during the last decades, along with the rise in disease prevalence and incidence. These new treatments exposed patients to various potential infections and promoted pre-treatment screening and vaccination. We aimed at assessing the published literature on different prophylactic screening and vaccination options in that period.Special attention was attributed to latest data assessing covid-19 vaccinations.MethodsWe have queried PubMed for all available IBD-related entries published during 2000–2020. The following data were extracted for each entry: PubMed unique article ID (PMID), title, publishing journal, abstract text, keywords (if any), and authors’ affiliations.Two gastrointestinal specialists decided in consensus on a list of terms to classify entries. The terms belonged to four groups: Opportunistic Infections, prophylactic screening, prophylactic vaccinations/treatment, regular vaccines. Annual trends of publications for the years 1980–2020 were plotted for different screening, vaccinations, and infections types. The slopes of publication trends were calculated by fitting regression lines to the annual number of publications.ResultsOverall, 98,339 IBD entries were published between 1980 and 2020. Of those, 10,128 entries belonged to one of the four investigated groups. Entries concerning opportunistic infections showed the sharpest rise, with 22 entries and 1980 to 623 entries in 2020 (slope 3.6, p<0.001). Entries concerning prophylactic screening rose from 10 entries in 1980 to 204 entries in 2020 (slope 1.4, p<0.001). Both entries concerning prophylactic vaccinations/treatments and regular vaccines did not show a significant rise (slope 0.08, and slope 0.22, respectively). Publications’ trend is shown in figure 1.Figure 1- publication trends of vaccines and opportunistic infections in IBD patients during the past four decades During COVID 19 pandemic a total of 44 publications were identified. Of them. 37 were relevant to vaccines and immune reaction. 19 publications (51%) were guidelines/recommendations, 14 (38%) assessed immune reaction to vaccination, most of them (11, 61%) to mRNA vaccines.Results are shown in figure 2.Figure2- publication trends of COVID 19 vaccines during the pandemic ConclusionAccording to publications trend analysis, during the past two decades, publications regarding opportunistic infections and prophylactic screening increased stteply compared to the two decades during pre- biologic area.During COVID -19 pandemic most publications included vaccinations’ recommendations and guidelines, and only 38% included real-world data assessing reaction to vaccinations. More research is needed.

Genetic Screening and Teratogenic Exposures: Considerations in Caring for the Uterus Transplant Patient.

Counseling the uterus transplant patient requires an enhanced knowledge of unique genetic challenges that include an understanding of the spectrum of Mayer-Rokitansky-Küster-Hauser syndrome. Patients should understand their options for genetic screening and testing including preimplantation genetic testing for aneuploidy, genetic screening, and diagnostic testing. This patient population is potentially at risk for fetal anomalies due to the increased susceptibility to infections, such as cytomegalovirus. There are management strategies to minimize this risk. The risk of teratogenicity from mycophenolate is eliminated by a washout period before embryo transfer.

Addressing rural health disparity with a novel hospital sleep apnea screening: Precision of a high-resolution pulse oximeter in screening for sleep-disordered breathing.

High-resolution pulse oximetry (HRPO) may offer a low-cost and simple screening option for sleep-disordered breathing (SDB) that could be vitally important in rural areas with limited healthcare resources and specialty care. Our team hypothesized that application of this technology to a broad cohort of rural dwelling hospitalized individuals would demonstrate congruence similar to previous urban studies comparing HRPO to portable sleep monitors. This retrospective study was conducted at West Virginia University Hospital and compared indices obtained from HRPO with those obtained from a type III portable sleep monitor (PM) on the same night. A total of 365 individuals underwent evaluation. The mean oxygen desaturation index (18.8 ± 19.3 events/h) from the HRPO was slightly higher than the mean respiratory event index (16.0 ± 18.1 events/h, p ≤ 0.001) from the PM. ROC curves were developed for thresholds of apnea severity predicted by the screening program. The AUC values for all three thresholds exceeded 0.92 and for a respiratory event index (REI) of ≥ 30 was 0.965. Indices from the PM and HRPO demonstrated agreement in those individuals with screening suggestive of moderatetosevere disease. This study demonstrates that use of HRPO in screening for SDB in hospitalized patients from rural communities is as accurate as PM and may serve as a simple cost-effective tool to address sleep health disparities in these regions with significant health inequity. Our data extend previous findings by applying HRPO to a larger hospitalized cohort with highly prevalent cardiopulmonary disease.

MHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework.

BackgroundThe ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options.ObjectiveThis study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework.MethodsFollowing a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use.ResultsMost apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results.ConclusionsThese results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support.

Primary care clinicians\u2019 opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial: a survey research study

BackgroundElectronic health record (EHR)-linked clinical decision support (CDS) may impact primary care clinicians’ (PCCs’) clinical care opinions. As part of a clinic cluster-randomized control trial (RCT) testing a cancer prevention and screening CDS system with patient and PCC printouts (with or without shared decision-making tools [SDMT]) for patients due for breast, cervical, colorectal, and lung cancer screening and/or human papillomavirus (HPV) vaccination compared to usual care (UC), we surveyed PCCs at study clinics pre- and post-CDS implementation. Our primary aim was to learn if PCCs' opinions changed over time within study arms. Secondary aims including examining whether PCCs' opinions in study arms differed both pre- and post-implementation, and gauging PCCs’ opinions on the CDS in the two intervention arms.MethodsThis study was conducted within a healthcare system serving an upper Midwestern population. We administered pre-implementation (11/2/2017–1/24/2018) and post-implementation (2/2/2020–4/9/2020) cross-sectional electronic surveys to PCCs practicing within a RCT arm: UC; CDS; or CDS + SDMT. Bivariate analyses compared responses between study arms at both time periods and longitudinally within study arms.ResultsPre-implementation (53%, n = 166) and post-implementation (57%, n = 172) response rates were similar. No significant differences in PCC responses were seen between study arms on cancer prevention and screening questions pre-implementation, with few significant differences found between study arms post-implementation. However, significantly fewer intervention arm clinic PCCs reported being very comfortable with discussing breast cancer screening options with patients compared to UC post-implementation, as well as compared to the same intervention arms pre-implementation. Other significant differences were noted within arms longitudinally. For intervention arms, these differences related to CDS areas like EHR alerts, risk calculators, and ordering screening. Most intervention arm PCCs noted the CDS provided overdue screening alerts to which they were unaware. Few PCCs reported using the CDS, but most would recommend it to colleagues, expressed high CDS satisfaction rates, and thought patients liked the CDS’s information and utility.ConclusionsWhile appreciated by PCCs with high satisfaction rates, the CDS may lower PCCs’ confidence regarding discussing patients’ breast cancer screening options and may be used irregularly. Future research will evaluate the impact of the CDS on cancer prevention and screening rates.Trial registrationclinicaltrials.gov, NCT02986230, December 6, 2016.

Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes.

Approximately 20%-30% of colorectal cancers (CRCs) arise from the serrated polyp pathway. CRC screening options have differential sensitivity to detect sessile serrated polyps (SSPs). We used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) to assess how the detection of SSPs impacts predicted life years gained (LYG), CRC incidence, and CRC mortality with multitarget stool DNA (mt-sDNA) or fecal immunochemical test (FIT) screening. A simulated cohort of average-risk US individuals underwent triennial mt-sDNA or annual FIT screening between ages 45-75 years. SSP-attributed CRCs were modeled at 0% (base case), 14.3%, 20%, and 30%, in combination with 4 adherence & attendance scenarios: S1: 100% stool-screening adherence/100% follow-up colonoscopy attendance after a positive stool test; S2: reported stool-screening adherence (mt-sDNA= 71%; FIT= 43%)/100% follow-up colonoscopy attendance; S3: reported stool-screening adherence/reported follow-up colonoscopy attendance (mt-sDNA= 72%; FIT= 47%); and S4: reported stool-screening adherence/72% follow-up colonoscopy attendance. Outcomes were per 1000 individuals. Sensitivity analyses used ranges of stool-screening adherence or follow-up attendance. At S1, S2, S3, and S4, LYG with FIT at the base case (0% SSP-attributed CRC) was 346.7, 279.3, 126.6, and 196.1, respectively, and with mt-sDNA was 324.6, 311.8, 215.8, and 215.8, respectively. Among the 4 adherence/attendance scenarios, modeling SSP-attributed CRCs decreased LYG by 4.9-20.9 with FIT and 2.0-5.1 with mt-sDNA. At S3 and 30% SSP-attributable CRCs, mt-sDNA had 95.1 more LYG, 21.5% greater CRC incidence reduction, and 22.2% greater CRC mortality reduction than FIT. Incorporating SSPs and real-world adherence into the CRC-AIM modeling analyses yielded more practice-relevant estimates of CRC screening outcomes and should be applied in future studies to afford more appropriate assessment of comparative effectiveness estimates between guideline-endorsed screening options.

HPV self-sampling: A viable option for cervical cancer screening in postpandemic era

HPV self-sampling: A viable option for cervical cancer screening in postpandemic era

Anesthesia in retinopathy of prematurity.

Retinopathy of prematurity (ROP) remains among the leading causes of childhood blindness. It affects mainly premature infants who tend to be systematically and clinically unstable and are more prone to complications and anesthesia related adverse effects when undergoing examination or treatment. A better comprehension of different analgesic and anesthetic methods used during screening and treatment may help in choosing a suitable option for ROP screening and treatment. An electronic search was done using MEDLINE, PubMed, and Embase databases. Search terms used included ROP, ROP, ROP screening, ROP treatment, analgesia, and anesthesia. All randomized clinical trials, large case series, and surveys were included in the review. Topical proparacaine is the most commonly used anesthesia during ROP screening and may significantly ease pain during ROP screening. Different comfort measures during screening may help infants recover faster but do not abolish pain. Topical tetracaine seems an effective pain-relieving option during intravitreal injections for ROP treatment. Photocoagulation of the peripheral retina under general anesthesia is considered the most common practice in the treatment of ROP. Further work is necessary to better understand the options of anesthesia methods offered for the treatment of ROP patients. This is a comprehensive review highlighting the available anesthetic methods for ROP patients to aid ophthalmologists in determining the most common and current anesthetic and analgesic practices.

Abstract PO-223: Examining racial differences in metastatic site and mortality among de novo stage IV colorectal cancer

Abstract Background: Racial disparities persist in colorectal cancer (CRC) incidence and survival despite advances in screening and therapeutic options. While the liver and lung are often described as common sites for CRC metastasis, the effect of race and ethnicity on the presentation of metastases remains largely unexplored. In this study, we investigate the racial differences in metastatic patterns of de novo stage IV CRC and associate these patterns with racial differences in CRC mortality. Methods: This retrospective cohort study used 18 Surveillance, Epidemiology and End Results (SEER) registries with data from 2010-2017 to identify 49,654 patients diagnosed with de novo metastatic, stage IV CRC. We evaluated the pattern of bone, lung, liver and brain metastases by race and ethnicity. Using multi-variate logistic regression, we obtained adjusted odds ratios (aOR) to estimate the association between metastatic pattern and race and ethnicity. We assessed the adjusted hazard ratios (aHR) for CRC-specific mortality and all-cause mortality by race and ethnicity using Cox proportional hazards regression models. Results: Of 49,654 patients, 63.5% were non-Hispanic White (NHW), 14.81% were NHB, and 12.6% were Hispanic. Majority of metastases were within the liver (72.3%) and lung (24.7%). The odds of metastasis to the liver was 1.13 times higher (95% CI, 1.06-1.20) and the odds of metastasis to lung was 1.19 times higher (95% CI, 1.09-1.23) in NHB than NHW patients. The odds of metastasis at any site was 1.19 times higher in NHB than NHW patients (95% CI, 1.10-1.28). The odds of metastasis to multiple sites was 1.16 times higher than to a single site for a NHB patient (95% CI, 1.09- 1.24). NHB patients had a higher adjusted hazard ratio of CRC-specific mortality when compared to NHW patients, overall (aHR 1.15, 95% CI 1.12-1.19); and when looking specifically at metastasis to the lung (aHR 1.10, 95% CI 1.04-1.16) and the liver (aHR 1.17, 95% CI 1.13-1.21). NHB had a 14% increased risk of mortality with metastases to multiple sites (aHR 1.14, 95% CI 1.07-1.121). Conclusion: In this retrospective cohort study, NHB patients presented more frequently with metastases at diagnosis and had higher odds of multiple metastases at diagnosis than their NHW counterparts, placing these patients at a higher risk of mortality. This study quantifies the ongoing severity of racial disparity that persists despite advances in CRC diagnostics and therapeutics. Targeted effort is needed at the prevention, screening and therapy levels, to create equity and improve CRC outcomes for the NHB patient population. Citation Format: Sakshi M. Dhar, Yunan Han, Adetunji Toriola. Examining racial differences in metastatic site and mortality among de novo stage IV colorectal cancer [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-223.

Technologies for Size-Based Analysis of Circulating Cell-Free DNA: Limitations and Clinical Implementation.

Prostate cancer is the second most common malignancy in men worldwide, and incidence is likely to rise in the next decade. The current screening options have limitations and have been shown to result in over-treatment of clinically insignificant disease. New biomarkers and technologies to detect them are therefore needed to better diagnose and stratify patients in primary care. Circulating cell-free DNA (ccfDNA) has gained interest as a potential minimally invasive biomarker, detectable in many bodily fluids (such as blood, urine, and cerebral spinal fluid) and reflecting the mutational landscape in tumors. More recently, the size distribution of ccfDNA fragments has also gained interest as a specific biomarker, where differences in size distribution have been observed between healthy volunteers and cancer patients, resulting in the new field of fragmentomics. Analysis of ccfDNA sizes provides avenues for alternative analytical technologies but commercial options are currently limited. Most focus on mutation detection and are subject to several biases that may affect size distribution. Here, we discuss the available technologies and identify major issues and considerations that may affect their implementation as a clinically useful test based on ccfDNA size profiling.

Optimal Noninvasive Colon Cancer Screening Modality in Patients Not Receiving Colonoscopy

Colon cancer is the third most common among cancer deaths in the US for both men and women. The incidence of colonoscopy has been soaring in younger patients, which led to changes in recent United States Preventive Services Task Force (USPSTF) guidelines to reduce the age for screening from 50 years to 45 years. Demand for colonoscopy services is surging due to increased incidences of colorectal cancer (CRC) in the both aging and younger population. Increased referrals have led to an insufficient workforce in hospitals and long waiting lists. Further, results from colonoscopy reveal a low percentage of CRC or another severe bowel disease (SBD). Therefore, colon cancer screening is a growing concern, particularly in patients who otherwise have a very long-life expectancy, and who are most likely to benefit from screening. Another reason to boost CRC screening is to minimize the load on hospitals by reducing the patients that undergo colonoscopy unnecessarily because only a low percentage of CRC occurrence is observed in individuals undergoing colonoscopy. In recent years, there are a variety of screening options available for CRC. Noninvasive alternatives include fecal immunochemical test (FIT), multitarget stool DNA testing (MT-sDNA, available under the brand name Cologuard), computed tomography (CT) colonography (previously called virtual colonoscopy), guaiac-based fecal occult blood testing (gFOBT), and capsule colonoscopy (CC). These tests have varied the degree of evidence supporting their use. This study focuses on the most recent survey and efficacy of noninvasive methods to prevent and detect colorectal cancer (CRC).

Abstract PO-264: Impact of health navigation program on healthy lifestyle and cancer screening in population with significant social determinants of health (SDOH) barriers

Abstract Objective: Assess consumer experience and health impact among under-resourced individuals who were enrolled into longitudinal navigation to address social determinants of health (SDOH) needs and health goals related to cancer primary and secondary prevention. Background: The Yale Cancer Disparities Firewall Project is a multi-tiered initiative to address the social determinants of health (SDOH) and other challenges that prevent at-risk communities from receiving the full benefit of the many available cancer prevention and cancer screening options. A community-facing health navigation program, staffed by community members who have received extensive multidisciplinary training is a central component of this program. Methods: Of the 61 currently enrolled individuals (all of whom are either African American/Black or Hispanic/Latinx), we collected questionnaire data from 24 individuals (39% response rate). In general, participants are enrolled for a minimum of 1 year, but most have been followed for 2 years. Respondents were similar to non-respondents with respect to race (60% were Black/African American vs 61.2%, respectively) and age (mean = 44.8 vs 47.2 years, respectively). Respondents were more likely to be female (85% vs 71.4%, p =.009), Hispanic/Latinx (35% vs 42%), but significantly less likely to be foreign-born (15% vs 26.5 %, p = .021). We assessed satisfaction with assigned navigator(s), uptake of referred services, knowledge gained, health behavior change, and self-rated health (SRH). Results: Per self-report, 79.2% of participants agreed and a further 12.5% somewhat agreed that they were overall satisfied with their experience with the health navigation program. Importantly, two-thirds (66.7%) agreed and a further 20.8% somewhat agreed that they changed their behavior to improve their health and well-being because of the program. Of the 5 health focused services offered, the most commonly reported uptake was physical activity (87.5%), followed by learning how to eat healthier and losing weight. Additionally, one third (33.3%) of participants received assistance with reducing or stopping smoking. In terms of secondary prevention, 62.5% of clients received assistance with cancer screening. Of the 5 SDOH focused services offered, the most common was assistance with finding food to eat (66.7%) followed by assistance with paying utilities (45.8%), a shift from the priority needs at baseline (40% needing food assistance, and 35% with housing concerns), presumably reflecting the additional strains associated with the COVID-19 pandemic. Conclusions: Against the backdrop of COVID-19, these findings suggest that addressing SDOH barriers through individual navigation is an important add-on service when facilitating access to services to maintain healthy lifestyle and adhere to cancer screening guidelines. Although this was a pilot program, we foresee the opportunity to utilize trained non-clinical navigators and/or community health workers and to promote cancer prevention in at risk communities. Citation Format: Monique K. Stefanou, Sakinah C. Suttiratana, Denise Stevens, Eduardo Reyes, Jonathan Colon, Eiman Ibrahim, Roy L. Herbst, Beth A. Jones. Impact of health navigation program on healthy lifestyle and cancer screening in population with significant social determinants of health (SDOH) barriers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-264.

Abstract PO-246: Correlates of HPV test history among African American and Sub-Saharan African immigrant women

Abstract Background: Human Papillomavirus (HPV) is the causative agent in nearly all cases of cervical cancer. Cervical cancer is preventable and treatable if detected early through regular screening. While Pap testing is a traditionally accepted screening option, HPV testing offers improved assurance of low cancer risk and reliable identification of cervical precancer and cancer. However, HPV testing is a relatively new testing option and remains underused. Black women, including Sub-Saharan African immigrants, have higher risk for cervical cancer incidence, mortality rates, and later stage of diagnosis for cervical cancer. The purpose of this study was to examine predictors of ever having had an HPV test among African American and Sub-Saharan African immigrant women. Methods: We conducted a cross-sectional 85-item survey with self-described African American or Sub-Saharan African immigrant women recruited from the community in a medium size city in the Southeastern US. Data included demographics, HPV and HPV testing knowledge, and HPV testing history. Logistic regression evaluated predictors of ever having had an HPV test. Results: The average age of the 91 women was 38.2 years (SD = 12.6) and almost two-thirds (65%) were African immigrants. The majority (84%) had ever had a Pap test and more than one-third (36%) had ever had a HPV test. Women were correct on less than half of the HPV knowledge 16-item scale (M = 7.1, SD = 4.7) and HPV testing knowledge was low, with women answering an average of less than two out of five items correctly (M = 1.8, SD = 1.5). Younger age (p=.004), higher education (p=.015), and higher HPV testing knowledge (p=.007) were significant predictors of having had an HPV test. Every one-year increase in age was associated with a 7% decrease in having had an HPV test (OR=.93, 95% CI = 0.88-0.98), while every one-level increase in education was associated with a 2-fold increase (OR=2.1, 95% CI=1.15-3.69). Every one-item increase in HPV testing knowledge was associated with an over two-fold increase in having had an HPV test (OR=2.1, 95% CI = 1.2-3.6). Conclusions: To ensure prompt diagnosis, follow up, and treatment, health care providers must stay abreast of updated screening guidelines and implement them. Future research should prioritize increasing knowledge and HPV testing among older women and those with lower educational attainment. c Citation Format: Adebola Adegboyega, Amanda Wiggins, Lovoria B. Williams, Mark Dignan. Correlates of HPV test history among African American and Sub-Saharan African immigrant women [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-246.

The COMPASS Study:&amp;nbsp;A Prospective, Randomized, Multi-Center Trial Testing the Impact of a Clinic-Based Intervention Informing Patients of Colorectal Cancer Screening Options on Screening Completion

The COMPASS Study:&amp;nbsp;A Prospective, Randomized, Multi-Center Trial Testing the Impact of a Clinic-Based Intervention Informing Patients of Colorectal Cancer Screening Options on Screening Completion

Clinical experience with non-invasive prenatal screening for single-gene disorders.

ABSTRACTObjectiveTo assess the performance of a non‐invasive prenatal screening test (NIPT) for a panel of dominant single‐gene disorders (SGD) with a combined population incidence of 1 in 600.MethodsCell‐free fetal DNA isolated from maternal plasma samples accessioned from 14 April 2017 to 27 November 2019 was analyzed by next‐generation sequencing, targeting 30 genes, to look for pathogenic or likely pathogenic variants implicated in 25 dominant conditions. The conditions included Noonan spectrum disorders, skeletal disorders, craniosynostosis syndromes, Cornelia de Lange syndrome, Alagille syndrome, tuberous sclerosis, epileptic encephalopathy, SYNGAP1‐related intellectual disability, CHARGE syndrome, Sotos syndrome and Rett syndrome. NIPT‐SGD was made available as a clinical service to women with a singleton pregnancy at ≥ 9 weeks' gestation, with testing on maternal and paternal genomic DNA to assist in interpretation. A minimum of 4.5% fetal fraction was required for test interpretation. Variants identified in the mother were deemed inconclusive with respect to fetal carrier status. Confirmatory prenatal or postnatal diagnostic testing was recommended for all screen‐positive patients and follow‐up information was requested. The screen‐positive rates with respect to the clinical indication for testing were evaluated.ResultsA NIPT‐SGD result was available for 2208 women, of which 125 (5.7%) were positive. Elevated test‐positive rates were observed for referrals with a family history of a disorder on the panel (20/132 (15.2%)) or a primary indication of fetal long‐bone abnormality (60/178 (33.7%)), fetal craniofacial abnormality (6/21 (28.6%)), fetal lymphatic abnormality (20/150 (13.3%)) or major fetal cardiac defect (4/31 (12.9%)). For paternal age ≥ 40 years as a sole risk factor, the test‐positive rate was 2/912 (0.2%). Of the 125 positive cases, follow‐up information was available for 67 (53.6%), with none classified as false‐positive. No false‐negative cases were identified.ConclusionsNIPT can assist in the early detection of a set of SGD, particularly when either abnormal ultrasound findings or a family history is present. Additional clinical studies are needed to evaluate the optimal design of the gene panel, define target populations and assess patient acceptability. NIPT‐SGD offers a safe and early prenatal screening option. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Provider-perceived barriers to patient adherence to colorectal cancer screening

BackgroundAverage-risk colorectal cancer (CRC) screening remains underutilized in the US. Provider recommendation is strongly associated with CRC screening completion. To inform interventions aimed at improving screening uptake, we examined providers’ perspectives on patient and health system barriers to CRC screening adherence, along with associated system-level interventions to improve uptake. MethodsWe conducted an online survey between November and December 2019 with a sample of primary care clinicians (PCCs) and gastroenterologists (GIs) from a validated panel of US clinicians (814 PCCs, 159 GIs; completion rates: 25.3% for PCCs, 29.6% for GIs). Clinicians rated the extent to which each patient and health system factor interferes with patient adherence with CRC screening recommendations and the availability of practice interventions to improve screening rates. ResultsProvider-reported top barriers to CRC screening included patient discomfort with offered screening method (66%), cost (62–64%), and perceived low importance of screening (62%). Additional barriers included providers prioritizing urgent health concerns over screening (45–48%), not offering a choice of screening options (42–48%), lacking time to educate patients about screening (38–45%), and lacking education about available screening options (37–40%). Most frequently reported system-level interventions to improve CRC screening rates included patient education materials (57–62%) and point of care prompts (56–61%). Other interventions were less frequently reported, although variations existed by clinical specialty regarding barriers and interventions. ConclusionsAddressing barriers to CRC screening requires system-level interventions, including provider training on shared decision-making, automated scheduling and reminder processes, and policies to increase clinician time for preventive screening consultations.

Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

BackgroundAntimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.ObjectiveWe assess the relative cost-effectiveness of screening programmes compared with no- screening.MethodsA microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.ResultsIn the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.ConclusionThe specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.