Breast Cancer Screening Rates Research Articles

Age-appropriate cancer screening: A cohort study of adults with psoriasis prescribed biologics, adults in the general population, and adults with hypertension

Psoriasis is associated with increased risk of developing and dying from cancer. To evaluate whether psoriasis patients who are prescribed biologics receive the recommended screening for cervical, breast, and colon cancer. We conducted a retrospective cohort study using the Optum deidentified Electronic Health Record data set. Incidence rates for cervical, breast, and colon cancer screening were compared between psoriasis patients who were prescribed biologics and 2 matched comparator cohorts: general patient population and patients being managed for hypertension. Multivariable Cox proportional hazards regression was performed to assess for differences in the rates of cancer screening. Compared with those in the general population without psoriasis, psoriasis patients who were prescribed biologics had higher screening rates for cervical cancer (adjusted hazard ratio [aHR] 1.09; 95% confidence interval [CI] 1.02-1.16) and colon cancer (aHR 1.10; 95% CI 1.02-1.18). Compared with those with hypertension, patients with psoriasis who were prescribed biologics had lower screening rates for breast cancer (aHR 0.88; 95% CI 0.83-0.94) and colon cancer (aHR 0.89; 95% CI 0.83-0.95). Patients with psoriasis who are prescribed biologic therapies may not be receiving adequate age-appropriate cancer screening, especially for breast and colon cancer.

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

Using an integrated social-behavioral text message approach to improve screening mammography in African American women.

240 Background: The rate of breast cancer among Black and White women is nearly equivalent but the death rate is 40% higher for Blacks. This disparity is often attributed to lower screening mammography rates in Black women. The effectiveness of text messages on increasing screening mammography among Black women is not well known. Importantly, the themes that are most effective at promoting behavioral changes in Black women’s breast cancer screening practices through text message interventions have not been explored. An integrated social-behavioral approach was used to identify themes associated with Black women’s response to two types of text messaging: reminder and educational texts. Methods: A qualitative study was conducted in Metropolitan Baltimore with two focus groups among Black breast cancer survivors. Participants completed a demographic survey and indicated text messaging practices and preferences for future breast screening texts via survey. Participants provided feedback on a series of 17 educational and reminder text messages. Focus groups were digitally recorded and transcribed for analysis. Text message preferences were analyzed using a content analysis approach. Multiple themes were identified, discussed and recorded. Results: 17 participants had an average age of 60. All participants reported cell phone ownership and 82% of participants reported texting. 46% reported an interest in reminder text messages and 54% reported an interest in educational text messages. Four main themes were derived from participants’ responses the text message series: 1) access to cancer care surveillance, 2) social network support, 3) patient-centered approach, and 4) self-advocacy. Text messages that included themes of self-advocacy, social network support, and patient-centered approach generated positive responses and the text messages that included access to cancer care surveillance were perceived as demotivating. Educational text messages were perceived to be more motivating than reminder text messages. Conclusions: Breast cancer screening behaviors are affected by various demographic, social-behavioral, and socioeconomic factors. The findings from this study suggest that developing an educational text message content that incorporates social and behavioral themes focusing on the patient may be more beneficial to improve breast cancer screening rates in this population.

Long-term impact of patient navigation (PN) for breast cancer (BCA) screening in an urban academic medical center.

130 Background: PN improves BCA screening rates in underserved women, and decreases health care disparities. However, there is limited data regarding the ability of PN effect sustained change. We evaluated the long-term impact of PN for BCA screening at our institution, by assessing the rate at which women who underwent screening mammogram (SM) in 2017, with the aid of PN, completed subsequent (f/u) SM within guideline-concordant time frames. Methods: Patients (pts) consisted of women seen by our institution’s primary care providers, with referral for SM in the electronic medical record (EMR), but without scheduled appointment, who received PN between June 1 and September 30, 2017, and successfully completed SM in 2017. Pts were identified from the screening navigation database. EMR was reviewed to obtain demographic data, rate of f/u SM, and time from 2017 SM to prior and f/u SM. Wilcoxon signed-rank test was used for analysis. Results: 179 pts completed SM with the aid of PN in 2017. Median age was 58 (range 37-77), 52.5% were Hispanic, 26.8% Black; and 2.8% Asian. Preferred languages were English (70.4%) and Spanish (25.7%). 6 pts had never had prior SM; 30 had no prior SM at our institution. Median time between 2017 SM and prior SM was 29 months (mo) (range 12-104); only 20 pts (11.2%) had a prior SM within 24 mo. 177 pts were eligible for f/u SM in 2018 and 2019 (1 diagnosed with BCA on 2017 SM; 1 died in 2017). 85 pts (48%) completed f/u SM; 68 (39%) completed within 24 mo. Only 2 pts required PN to complete f/u SM. In pts with time to screening data available for both 2017 SM and f/u SM (n = 80), median time to SM improved from 24 to 16 mo (p < 0.01). Decreases were seen in Black (22 to 14 mo, p < 0.01), White (31 to 16 mo, p = 0.03), and Hispanic pts (28 to 18.5 mo, p < 0.01), and in English (22 to 15 mo, p < 0.01) and Spanish speakers (26 to 20 mo, p < 0.01). Conclusions: A single episode of PN for BCA screening had a sustained impact on pts at our institution, leading to improved compliance with future SM. Improvement was seen in pts of diverse races, ethnicities, and language preferences. Focused PN for pts who did not complete f/u SM is planned.

Distribution and predictors associated with the use of breast cancer screening services among women in 14 low-resource countries

BackgroundBreast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs.MethodsThe present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services.ResultsThe utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85–84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67–14.96%) in American countries, and 14.29% (95% CI: 13.87–14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women.ConclusionThe utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.

Non-Invasive Biomarkers for Early Detection of Breast Cancer.

Simple SummaryEarly diagnosis of breast cancer greatly increases the chance of cure and survival from the disease. The mammogram is widely used for early detection of breast cancer, but its effectiveness and accuracy have been a concern for a long time as well as its inability in detecting small cancers, especially in women with dense breast tissues. Therefore, it is an unmet clinical need to develop a simple, convenient test to overcome the shortcomings of mammography. Liquid biopsy, which is based on the analysis of body fluids, has attracted much attention in the search for cancer biomarkers. Recent advances in analytical techniques have gradually made it possible to detect breast cancer early through a biomarker analysis of blood, nipple aspirate fluid, sweat, urine, tears, or the breath. We envision that a simple blood or breath test holds great promise as a biomarker for early detection of breast cancer in the near future.Breast cancer is the most common cancer in women worldwide. Accurate early diagnosis of breast cancer is critical in the management of the disease. Although mammogram screening has been widely used for breast cancer screening, high false-positive and false-negative rates and radiation from mammography have always been a concern. Over the last 20 years, the emergence of “omics” strategies has resulted in significant advances in the search for non-invasive biomarkers for breast cancer diagnosis at an early stage. Circulating carcinoma antigens, circulating tumor cells, circulating cell-free tumor nucleic acids (DNA or RNA), circulating microRNAs, and circulating extracellular vesicles in the peripheral blood, nipple aspirate fluid, sweat, urine, and tears, as well as volatile organic compounds in the breath, have emerged as potential non-invasive diagnostic biomarkers to supplement current clinical approaches to earlier detection of breast cancer. In this review, we summarize the current progress of research in these areas.

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis.

This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.

Abstract D020: Addressing the needs of Cedars-Sinai Cancer’s catchment area: Cancer screening compliance among the Korean community in Los Angeles

Abstract Background: Breast cancer screening rates among Korean American women lag behind other populations in the US; additionally, this population has the lowest mammography adherence rates of all the Asian subgroups. The rates of invasive breast cancer among Korean women in Los Angeles County (LAC) have also increased dramatically, which leads to poor outcomes. Early detection of breast cancer provides a greater range of treatment options and often better survival rates. Given this, we want to understand the unique barriers that Korean women in LAC face in order to adequately serve our catchment area. Methods: To understand the context of cancer screening compliance among Koreans in LAC, the Research Center for Health Equity (RCHE) at Cedars-Sinai Medical Center conducted a culturally adapted survey within its catchment area. We developed a Cancer and Healthcare in Los Angeles Survey (CHILAS) with feedback from Korean community leaders. The survey targeting females has 31 questions and covers screening behavior, medical history, and health care access. The survey was adapted with feedback from Korean community leaders and printed in the Korean language. A free cancer education workshop was offered post survey. For the purposes of the current analyses, we focused on participants were Korean women >= 18 yrs who reside in LAC. Surveys were administered at seven different faith-based venues, such as churches and Buddhist temples, during a three-month period. Results: 126 female participants were age eligible (age 45 and above) to answer the mammography screening cancer question and 52 (41.3%) of them had their screening up to date. 113 participants answered both the question about mammography screening and knowing someone with cancer. Of those who ‘knew someone with cancer’ (N=75), 46% had their screening up to date (N=35). Of those who ‘did not know someone with cancer’ (N=38), 34% had their screening up to date (N=13), the difference was not significant (p-value =0.21). Two of the top reasons for not getting screened were 1) not feeling sick and 2) no health insurance. Moreover, speaking the same language as the primary provider, financial status, length of waiting for an appointment, and transportation were not associated with breast cancer screening. Although mammography rates were low, colonoscopy rates among age eligible participants in the survey were very high (94.5%), leading us to believe there are unique factors to low mammography screening in Korean women. Future direction: To our knowledge, there are no existing awareness programs to increase mammography screening for this population. We know that faith-based organizations can increase screening behaviors among parishioners and can be an effective avenue for improving health outcomes. Through the engagement with elders, RCHE has formed an extensive network of partnerships with faith-based organizations we will identify the unique barriers to mammography compliance in Korean Americans. Citation Format: Dong Hee Kim, Yu-Chen Lin, Christie Y. Jeon, Laurel Finster, A. Joan Levine, Zul Surani, Robert W. Haile. Addressing the needs of Cedars-Sinai Cancer’s catchment area: Cancer screening compliance among the Korean community in Los Angeles [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D020.

Abstract B017: Rural interventions for screening effectiveness: Baseline cancer screening behaviors of rural women of Indiana and Ohio

Abstract Rural areas of the United States experience increased cancer incidence and mortality rates and lower cancer screening rates compared to urban areas. According to the National Center for Health Statistics, Ohio and Indiana are ranked 8th and 10th highest, respectively, for cancer mortality rates nationally. The Rural Interventions for Screening Effectiveness (RISE) Study conducted by The Ohio State University and Indiana University focuses on improving breast, cervical and colorectal cancer screening rates in rural areas of both states to reduce this cancer burden. RISE is testing two interventions to educate and encourage women in rural counties of Ohio and Indiana ages 50-74 years to complete any needed screenings. Participants complete baseline and 12-month surveys and receive usual care brochures, an interactive DVD, or the DVD along with phone-based assistance from a patient navigator. In order to be eligible to participate, women must be residents of a rural county of either state, outside of guidelines for breast, cervical, and/or colorectal cancer screening per medical record review, and have no personal history of inflammatory bowel disease, cancer (except non-melanoma skin cancer), or genetic conditions that increase cancer risk. Baseline demographic and cancer screening history data were collected from 1634 women (1041 Ohio, 593 Indiana), and 985 were ultimately eligible and enrolled in the study (599 Ohio, 386 Indiana). Women who were within guidelines for all three screening tests were excluded from the study; 442 (42.5%) in Ohio and 207 (34.9%) in Indiana. A larger proportion of Indiana women were outside of guidelines for all three screening tests (80 of 593 (13.5%)) compared to Ohio women (107 of 1041 (10.3%)). Across both states, more women were adherent to breast cancer screening guidelines (75.3%) than cervical (66%) or colorectal cancer screening guidelines (58.8%). A comparison of screening behaviors of Indiana and Ohio participants will be conducted to determine if differences between the two exist. Analyses will focus on being inside or outside of guidelines by individual test (breast, cervical, and colorectal) and all three tests combined. Although rural women of Midwest states are often considered to be very similar, differences in screening behaviors exist, even between women of neighboring states, and future efforts to improve the cancer burden in rural women could benefit from considering factors that contribute to these differences, such as access to quality care. Citation Format: Electra D Paskett, Ryan D Baltic, Mira L Katz, Gregory S Young, Susan Rawl, Victoria Champion. Rural interventions for screening effectiveness: Baseline cancer screening behaviors of rural women of Indiana and Ohio [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B017.

Abstract IA12: Border Health Consortium of the Californias

Abstract San Diego County is a minority-majority region, in which non-Hispanic whites are not the majority population (46%). Hispanics comprise 33.5% of the population and Asian Pacific Islanders (APIs) make up 12.8%. For risk factor burden, data based on California Health Interview Survey and Behavioral Risk Factor Surveillance System show that Hispanics in San Diego County have the lowest colorectal, breast, and cervix cancer screening rates, the highest obesity prevalence, and the highest proportion of no physical activity. The mission of the Border Health Consortium of the Californias-Binational Cancer Work Group is to promote cancer-free lives and erase borders in our region. We will identify and characterize priority cancer topics for our border region, organize along the cancer control continuum, identify key border region cancer activities and resources (binational), and identify key border region cancer needs (binational). To reach our objectives we will optimize collaboration, coordination, and cooperation. Citation Format: Prisci Quijada. Border Health Consortium of the Californias [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA12.

Abstract B001: Rural interventions to improve breast, cervical and colorectal screening rates: Recruitment strategies for women in rural areas

Abstract Rural areas of the United States have less access to quality healthcare, higher rates of cancer incidence and mortality, and lower screening rates compared to urban areas. The Rural Interventions for Screening Effectiveness (RISE) Study conducted by Indiana University and The Ohio State University focuses on improving breast, cervical and colorectal cancer screening rates in rural Indiana and Ohio by encouraging female residents ages 50-74 years to receive necessary screenings. Two interventions are tested: an interactive DVD, and the DVD combined with patient navigation. Recruitment occurred October 2017 - June 2019. This paper evaluates recruitment strategies used by RISE in order to better understand which method was most effective and to determine if participants differed demographically by recruitment method. An array of recruitment strategies were used, including purchasing contact lists to call women in the recruitment area, internet advertising, and physical advertisements placed within the communities. Outbound mailing and calling, the sole method initially planned, was performed for the first 6 months of recruitment, using purchased phone and address lists of female residents of rural counties of northeast Indiana and northwest Ohio. Internet advertising was primarily conducted using Facebook to target female users 50 years or older in rural areas of both states. Community advertising was performed by mailing flyers to be displayed in rural libraries, senior and community centers, and other locations where residents congregate. Recruitment strategies differed in effort, cost, and yield. Mailing and calling using purchased lists was used to attempt to reach 5240 women, successfully reaching and reviewing medical records for 275 women, yielding 154 eligible women. Median household income of these women was $50,000-$59,999 and median age was 63 years. This strategy was costly, high effort, and did not yield enough participants to warrant continuing. Community advertising involved identifying suitable locations and requesting permission to post promotional materials. Although this strategy’s reach cannot be determined, 163 women contacted staff to request more information, 67 progressed to medical record review, and 38 were enrolled. Median household income of these participants was $70,000-$79,999 and median age was 62 years. Through Internet advertising, 3116 spoke to interviewers about the study, with 1297 progressing to medical record review, yielding 793 eligible participants. Median household income was $70,000-$79,999; median age was 58 years. Although Internet recruitment was the most successful strategy, it may have unintentionally targeted younger or more affluent women who own and use smartphones or home computers with internet access. With technology becoming increasingly pervasive and as people become more hesitant to answer phone calls from foreign numbers, recruitment strategies must be evaluated to ensure the study population is truly being reached. Citation Format: Ryan D Baltic, Gregory S Young, Mira L Katz, Susan Rawl, Victoria Champion, Electra D Paskett. Rural interventions to improve breast, cervical and colorectal screening rates: Recruitment strategies for women in rural areas [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B001.

Abstract B108: Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago

Abstract Background: Under-resourced women are subject to many factors that increase their risk of morbidity and mortality from breast cancer, such as being uninsured or underinsured and not having a medical home or primary care provider. They may also lack additional resources to access care such as transportation. Due to variance in mammography recommendations among health organizations, lack of knowledge or confusion about when to receive screening also poses a challenge to both women and providers. Objective: A partnership between University of Illinois (UI) Cancer Center, UI Hospital & Health System, and Chicago Department of Public Health was developed to initiate an implementation science program that aims to mitigate these barriers by providing free breast cancer screening services and patient navigation to under-resourced women at our Mile Square Federally Qualified Health Centers (FQHCs). The program also aims to increase community partnerships to extend community outreach and identify factors that facilitate or challenge women's access to breast care services. Methods: Breast health screening and navigation services are offered at 5 Mile Square FQHC clinics and through “mammography party” events with community partners. Navigators facilitate women's care through screening and any follow-up services, link patients to additional resources, and provide breast health education. Data obtained through electronic medical records and direct correspondence with women and providers are managed securely in REDCap and analyzed with SPSS software. A program evaluation will be implemented in September 2018. Program activities are ongoing. Results: Four hundred ten women completed a screening mammogram from August 1, 2017 to June 30, 2018. Ninety-seven percent of women were racial minorities, most of whom were Latina (60.2%), African American (31.5%) and uninsured (67.8%). Among this cohort of women, the recall rate (24.6%) and cancer detection rate (17 per 1000) exceeded Breast Cancer Surveillance Consortium 2013 recall and cancer detection rate benchmarks (11.5% and 4.8 per 1000, respectively). Ages of women diagnosed (n=7) ranged from 40 to 68 years. The majority of diagnosed women were uninsured (n=6), 4 of whom were not eligible for health insurance. Conclusion: Patient navigation has proven to be effective in increasing breast cancer screening rates, access to care and resources, and disseminating breast health education; however, systematic barriers to care still persist. Although the Affordable Care Act has been instrumental in increasing the number of insured Americans, health care costs still pose a significant challenge for those who are underinsured or not eligible to be insured. Additionally, our data imply that some recommended guidelines for mammography may not address the screening needs for women who are at higher risk for breast cancer, and more personalized screening based on a woman's individual risk factors may be instrumental in ameliorating breast cancer disparities. Citation Format: Vida Henderson, Karriem Watson, Kathy Tossas-Milligan, Erica Martinez, Mariela Rodriguez, Barbara Williams, Paola Torres, Lisa Aponte-Soto, Robert Winn. Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B108.

Improving Breast Cancer Screening Rates in a Resident Clinic in Eastern North Carolina.

Improving Breast Cancer Screening Rates in a Resident Clinic in Eastern North Carolina.

Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women

Breast cancer is a common cancer among women in the US and cultural barriers and medical mistrust have been associated with breast cancer screening (BCS) rates among minority populations. A heterogeneous sample of Arab women (N = 196) were recruited from across the Detroit metropolitan area and administered a questionnaire. Multiple regression analyses revealed an association between Arab Cultural Specific Barriers (ACSB) to BCS and Group-Based Medical Mistrust Scale. The environmental ACSB to BCS was associated with the medical mistrust-suspicion of HC providers (β = 0.363, p = 0.01), lack of HC provider support (β = 0.396, p = 0.001), and Arab inequities (β = 0.250, p = 0.05). Findings suggest that ACSB to BCS are predictive of medical mistrust for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to BCS that Arab American women face in the health care system.

Inappropriate colorectal and breast cancer screening in patients with advanced cancer.

e19197 Background: Despite the low five-year expected survival of patients with advanced cancer, it has been suggested that up to 1.7% of patients aged 65 and older with advanced cancer may continue to undergo screening for colorectal cancer and up to 8.9% of female patients 65 and older with an advanced cancer may receive a screening mammography.1 The intent of our study was to determine the rate of colorectal and breast cancer screening in men ages 50-75 and women ages 40-75 after these patients were diagnosed with an advanced cancer. Methods: The medical records of 208 patients (median age 63.5, range 42-75) with a diagnosis of stage IV colorectal, prostate, breast, liver, gastroesophageal, skin, uterine, bladder, kidney and stage III-IV pancreatic and lung cancer were reviewed for documentation of a screening mammography, colonoscopy or FIT-DNA testing after the patient was diagnosed with an advanced cancer. Results: Overall, 4.8% of patients were screened for colorectal cancer and 10% of the females received at least one mammogram. The screening mammography rate in patients less than 64 years of age was 13.3% and the colorectal screening rate in this age group was 4.4%. In patients 65 and older, the screening mammography rate was 7% and the colorectal screening rate was 5.2%. Conclusions: Colorectal and breast cancer screening rates in patients with advanced cancer were higher within our fully integrated healthcare system in comparison to previously reported findings in patients 65 and older. In addition, the rate of screening with mammography may be more prevalent amongst patients 64 or younger with advanced cancer in comparison to patients 65 and older with a similar diagnosis. The next phase of this quality improvement project involves disabling health maintenance prompts within the electronic medical record of patients with advanced cancer.

Affordable Care Act State-Specific Medicaid Expansion: Impact on Health Insurance Coverage and Breast Cancer Screening Rate

Under the Affordable Care Act, states were given the option to expand Medicaid in 2014. By the end of 2014, 32 states had opted to expand Medicaid and 19 did not. Previous quasi-experimental studies took advantage of this state-specific policy implementation and found increased insurance coverage in expansion compared with nonexpansion states. With longer-term data now available, we studied the effect of Medicaid expansion on changes in insurance coverage and mammography rates in expansion and nonexpansion states. Seven states that expanded Medicaid eligibility in 2014 and 6 nonexpansion states were selected based on available data. The US Census American Community Survey was queried for insurance coverage from 2011 to 2016 and the CDC Behavioral Risk Factor Surveillance System from 2010 to 2018. Difference-in-difference linear mixed models were used to estimate and compare insurance coverage and screening mammogram rates between expansion and nonexpansion states before and after2014. The increase in insurance rates for all persons covered by some type of health insurance after Medicaid expansion was significantly different in expansion than nonexpansion states (p=0.001). The increase in Medicaid coverage was significant in expansion compared with nonexpansion states (p < 0.001). A similar trend was seen in screening mammogram rates in women from low-income households in expansion vs nonexpansion states (p= 0.049). Medicaid expansion states saw greater improvement in total insurance and Medicaid coverage, and in mammogram rates in lower-income women compared with nonexpansion states after Medicaid legislation was passed. Our study demonstrates that people do take advantage of expanded eligibility by acquiring insurance and this can improve access to preventive measures, such as screening mammography.

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates. To examine the association between area deprivation, rurality, and screening for breast, cervical, and colorectal cancer in patients from an integrated health care delivery system in 3 US Midwest states (Minnesota, Iowa, and Wisconsin). In this cross-sectional study of adults receiving primary care at 75 primary care practices in Minnesota, Iowa, and Wisconsin, rates of recommended breast, cervical, and colorectal cancer screening completion were ascertained using electronic health records between July 1, 2016, and June 30, 2017. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators and was calculated for all census block groups in Minnesota, Iowa, and Wisconsin (11 230 census block groups). Rurality was defined at the zip code level. Using multivariable logistic regression, this study examined the association between the ADI, rurality, and completion of cancer screening after adjusting for age, Charlson Comorbidity Index, race, and sex (for colorectal cancer only). Completion of recommended breast, cervical, and colorectal cancer screening. The study cohorts were composed of 78 302 patients eligible for breast cancer screening (mean [SD] age, 61.8 [7.1] years), 126 731 patients eligible for cervical cancer screening (mean [SD] age, 42.6 [13.2] years), and 145 550 patients eligible for colorectal cancer screening (mean [SD] age, 62.4 [7.0] years; 52.9% [77 048 of 145 550] female). The odds of completing recommended screening were decreased for individuals living in the most deprived (highest ADI) census block group quintile compared with the least deprived (lowest ADI) quintile: the odds ratios were 0.51 (95% CI, 0.46-0.57) for breast cancer, 0.58 (95% CI, 0.54-0.62) for cervical cancer, and 0.57 (95% CI, 0.53-0.61) for colorectal cancer. Individuals living in rural areas compared with urban areas also had lower rates of cancer screening: the odds ratios were 0.76 (95% CI, 0.72-0.79) for breast cancer, 0.81 (95% CI, 0.79-0.83) for cervical cancer, and 0.93 (95% CI, 0.91-0.96) for colorectal cancer. Individuals living in areas of greater deprivation and rurality had lower rates of recommended cancer screening, signaling the need for effective intervention strategies that may include improved community partnerships and patient engagement to enhance access to screening in highest-risk populations.

Reduction from 2011 to 2017 in adherence to breast cancer screening and non-improvement in the uptake of cervical cancer screening among women living in Spain

ObjectivesTo analyze the uptake of breast and cervical cancer screening according to the 2017 Spanish National Health Survey (SNHS), to compare uptake rates with those obtained in the previous SNHS 2011 and to identify predictors for the uptake for these two screening tests. Study designCross-sectional study. Main outcome measuresUptake rates of breast cancer and cervical cancer screening were analyzed for women aged 40–69 and aged 25–65 years, respectively. Independent variables included sociodemographic characteristics and factors related to health status and lifestyle. ResultsWe found that 66.8 % of women aged 40–69 years had undergone mammography in the previous two years. Positive predictors for mammography uptake were age (50–69 years); marital status (married); Spanish nationality; university education; one or more chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. We observed that 73.0 % of women aged 25–65 years had undergone cervical cytology screening in the previous three years. Positive predictors for uptake were age (25–52 years); marital status (married); Spanish nationality; middle-high educational level; no chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. There was a significant decrease in the uptake rate for breast cancer screening from the previous SNHS 2011 (OR 0.89; 95 % CI 0.83–0.94). ConclusionsThe adherence rate for mammography in Spain in 2017 was below the recommended 70 % and was significantly lower than in 2011. The figures for cervical cancer screening were over 70 % and stable over time.

Social Determinants of Breast Cancer Screening among Married Women: A Cross-Sectional Study.

Background: Regular cancer screening is the best way for early detection of breast cancer, but studies showed the low participation rates of screening in Iran. We aimed to determine breast cancer screening among married women and related factors in North of Iran. Study design: A cross-sectional study. Methods: This cross-sectional study was carried out from Jan to Mar 2017 among 1472 married women in an urban population in Rasht City, North of Iran. Data were collected using a questionnaire included socio-demographic information and breast cancer screening behaviors. Descriptive statistics, chi-square and logistic regression were used for data analyzing with SPSS. Results: The mean age of women was 35.1 ±6.5 years. Majority of women never performed clinical breast examination (70.7%) and regular monthly breast self-examination (52.2%). Only women over 40 yr performed mammography. Mammography performance was associated with health insurance (OR=4.99; 95% CI: 1.10, 22.53) and family history (OR=1.60; 95% CI: 1.19, 2.19), clinical breast examination was associated with age of women (OR=2.87; 95% CI: 1.90, 4.32) and breast selfexamination was associated with age and occupation of women [OR=1.67; 95 % CI: 1.16, 2.39, OR=1.65; 95% CI: 1.19, 2.29) respectively]. Conclusion: The rate of breast cancer screening was low among married women. Therefore considering the structural and cultural barriers, effective health education is essential to reduce inequality and increase the efficiency of screening programs.

Breast, Cervical, and Colorectal Cancer Screening Adherence: Effect of Low Body Mass Index in Women.

Purpose: Health-related behaviors among underweight women have received less attention than overweight and obese women in the United States. Our purposes were to estimate the rate and modifiers of breast, cervical, and colorectal cancer screening adherence among underweight women and compare it to other body mass index (BMI) categories. Materials and Methods: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System (BRFSS) of age-eligible women (breast cancer screening, n = 163,164; cervical, n = 113,883 and colorectal, n = 128,287). We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force (USPSTF) guidelines. We calculated the prevalence of screening among four BMI categories (underweight <18.5, normal weight ≥18.5 to <25, overweight ≥25 to <30, and obese ≥30). Logistic regression models assessed the independent effect of BMI on screening adherence. Results: Underweight women had significantly lower breast (62.9%), cervical (67.5%), and colorectal (62.6%) cancer screening rates compared to other BMI categories. In logistic regression models, being underweight was associated with decreased odds of breast (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.49-0.88) and cervical (OR = 0.54, 95% CI = 0.34-0.84), but not colorectal (OR = 0.88; 95% CI = 0.66-1.18) cancer screening adherence. We did not demonstrate a significant association between obesity and screening rates for any of the three cancers. Underweight women reported higher rates of smoking and lower levels of educational attainment, income, and insurance coverage compared to all other groups. Higher rates of chronic illness and health access hardship were observed among underweight women. Conclusion: BMI variably affects cancer screening. Compared to normal-weight women, being underweight is associated with breast and cervical cancer screening nonadherence. Promoting breast and cervical cancer screening among this currently underserved population may reduce future disparities.