Screening Uptake Research Articles

Comparing the effectiveness and cost-effectiveness of text-message reminders and telephone patient navigation to improve the uptake of faecal immunochemical test screening among non-responders in London: a randomised controlled trial protocol

IntroductionParticipation in bowel cancer screening is lower in regions where there is high ethnic diversity and/or socioeconomic deprivation. Interventions, such as text message reminders and patient navigation (PN), have the...

The effect of mailed outreach on FIT completion among patients aged 45-50 in a safety net healthcare system.

Colorectal cancer screening is recommended starting at age 45, but there has been little research on strategies to promote screening in patients younger than 50. An outreach program quasi-randomly assigned patients aged 45-50 without recent fecal immunochemical test (FIT), colonoscopy or contraindications to screening to two intervention arms: electronic outreach with email and text (electronic outreach only)versus electronic outreach plus mailed outreach with FIT, an instructional letter and a prepaid return envelope (mailed + electronic outreach). In response to known disparities in screening uptake, all Black patients were assigned to receive mailed + electronic outreach. Among patients quasi-randomly assigned to an intervention (non-Black patients), the 180-day FIT completion rate was 18.8% in the electronic outreach only group (n = 1,318) and 25.0% in the mailed + electronic outreach group (n = 1,364) (difference 6.2% [95% CI 3.0, 9.4]). FIT completion was 16.6% among Black patients (n = 469), 8.4% (95% CI 4.1, 12.6) lower than among non-Black patients also assigned to mailed + electronic outreach. Among patients aged 45-50, mailed + electronic outreach had a greater effect on FIT completion than electronic outreach alone. Crossover between intervention groups likely lead to an underestimation of the effect of mailed outreach.

Patterns of screening and access to care in women diagnosed with breast cancer in a safety-net system.

1531 Background: Screening mammography reduces breast cancer specific mortality by allowing diagnosis at an earlier stage. Inconsistent guidelines and limitations in access to primary care are among factors that affect screening uptake. In this study, we reviewed patient characteristics, access to care, and uptake of screening mammogram (SMMG) prior to a breast cancer diagnosis at a safety-net system. Methods: Parkland Health (PH) is the safety-net system for Dallas County and is affiliated with the University of Texas Southwestern Simmons Comprehensive Cancer Center. Electronic medical records of patients with a new invasive breast cancer diagnosis between 2018 and 2019 at PH were reviewed and data on demographics and clinical presentation were collected. Patients were categorized based on SMMG uptake prior to their cancer diagnosis: never-screened, ever-screened (SMMG > 2 years prior to diagnosis) and recent-screened (SMMG within 2 years of diagnosis). Results: A total of 468 new breast cancer cases were identified (48.7% Hispanic; 32.9% Black). Of these, 12.2% were younger than 40 and 27.8% were 40-49. Payer mix included 64.7% uninsured and 34.8% Medicare/Medicaid. Half of the patients (50.6%) never had SMMG. Never-screened rate was higher among younger patients (98.2% in < 40; 53.8% in 40-49; and 39.4% in >50; p < 0.0001). Only 25.2% (118/468) of the patients had a SMMG within 2 years prior to their diagnosis. Among patients aged >40, 44.0% (181/411) were never-screened and 28.7% (118/411) were recent-screened. Screen-detection rate among patients >40 was 40.1% (165/411), of whom 22 (13.3% of screen-detects) were diagnosed with cancer on their first ever SMMG. Race/ethnicity, insurance status, and positive family history of cancer were not significantly different between never, ever, and recent-screened patients. Screening uptake correlated with nodal status, tumor size and stage at diagnosis. Patients who had a prior encounter at Parkland were more likely to have a SMMG. Patients established with Parkland primary care at diagnosis were more likely to have early-stage disease. In patients < 40, 24.6% presented with stage IV disease at diagnosis and 57.9% did not have a primary care provider. A positive family history of breast/ovarian cancer or any cancer was noted in 38.6% and 57.9% of patients < 40, respectively. Conclusions: In the cohort presented here, 27.8% of patients were between age 40-49, reflecting the impact of a gap in the guideline, which is now addressed in the most recent iteration of USPSTF guidelines. Connecting ED users to primary care, identifying higher risk individuals through family history, and increasing SMMG rate in the primary care setting are among strategies to reduce the rate of late-stage diagnosis of breast cancer, particularly among vulnerable patient populations.

Feasibility of universal breast cancer risk assessment in a diverse, publicly insured obstetrician gynecology clinic.

e13759 Background: Breast cancer is the most diagnosed cancer among women in the United States. Established breast cancer risk assessment (BCRA) tools can estimate a woman’s lifetime risk and inform the need for enhanced breast screening which can improve cancer-associated morbidity and mortality. Currently, critical disparities exist both in breast cancer prognosis and screening uptake. We aimed to evaluate the feasibility of routine BCRA in a diverse, publicly insured obstetrician gynecology clinic. Methods: All patients presenting to the obstetrician gynecology clinic were offered a BCRA using the Tyrer Cuzick (TC) risk model. Patients completed paper surveys and the information was input into the TC model to generate lifetime risk estimates. Printed evidence-based management guidelines were reviewed with and provided to those at ≥ 20% lifetime breast cancer risk and shared with the patient’s provider. Results: Between June 2023 and February 2024, 300 patients were approached and 208 (69.3%) completed the survey. One hundred seven (51.4%) survey respondents were presenting for obstetrical care and 101 (48.6%) for gynecologic care. Respondents had a median age of 33 years (IQR: 12). Ninety-six (46.2%) responding patients self-identified as Hispanic, 45 (21.6%) as Black, 25 (12.0%) as Asian, 28 (13.5%) as Non-Hispanic White, and 14 (6.7%) did not identify in these categories. One hundred eighty-nine (90.9%) survey respondents were publicly-insured. Ten (4.8%) patients were assisted by an interpreter. Overall, 12 (5.8%) patients had an elevated lifetime breast of breast cancer, defined as ≥ 20% based on the TC model (6 (50.0%) among obstetrical patients and 6 (50.0%) among gynecology patients). All patients at elevated risk were referred to a genetics clinic for counseling on options for enhanced breast surveillance. Conclusions: As leaders in women’s cancer care, gynecologic oncologists can lead and support programs to identify those women at highest risk for cancer, especially among historically underserved populations. Our feasibility study demonstrated that 69.3% of patients were willing to complete a BRCA and this tool identified 5.8% of patients to have a significantly elevated lifetime breast cancer risk. Providers should consider incorporating such tools in gynecologic oncology and obstetrical/gynecology clinics.

Provision of cervical cancer services for women living with HIV, Uganda.

To describe the scale-up of cervical cancer screening and treatment for women living with human immunodeficiency virus (HIV), aged 25-49years in Uganda, and to analyse the programme data. The health ministry targeted existing HIV clinics in a 2-year scale-up of cervical cancer screening services from October 2020. In preparation, we trained health workers to assess women attending HIV clinics for screening eligibility, provided either by human papillomavirus (HPV) testing and/or visual inspection with acetic acid. Clinic staff treated women with precancerous cervical lesions with thermocoagulation or referred women with suspected cancer to external services. We analysed data reported every 6months for the number of clinics offering screening, screening uptake, the number of positive diagnoses and the number of women who received treatment. The number of HIV clinics offering cervical cancer screening services increased from 11, before the programme launch, to 1571. During the programme, screening uptake increased from 5.0% (6506/130 293) to 107.3% (151 872/141 527) of targets. The cumulative proportion of positive diagnoses was 5.9% (23 970/407 323) overall, but was much lower for screening offering visual inspection only compared with clinics offering HPV testing. Although the proportion of women receiving treatment if positive increased from 12.8% (53/413) to 84.3% (8087/9592), the World Health Organization target of 90% was not reached. We demonstrated marked increases, potentially replicable by other countries, in screening and treatment. These increases could be improved further by expanding HPV testing and same-day treatment of precancerous lesions.

Patterns of cancer screening practice and mutational status of cancer-predisposing genes among individuals at high risk for cancer.

10557 Background: Research on cancer screening practice and prevention strategies among individuals at high risk for cancer is limited. We explored the patterns of screening practice of seven cancer types in high-risk patients (pts) at a single institution. Methods: Between June-September 2023, we conducted a follow-up survey on pts enrolled in the University of Chicago Cancer Prone Study, a longitudinal cohort of high-risk families initiated in 1992. We assessed breast, cervical, colorectal, prostate (PSA), ovarian, skin (full-body skin exam [FBSE]), and lung cancer screening by mutational status. Results: Of 912 respondents, 80.4% were female. 81.6% were White, followed by 10.6% Black, 4.0% other/multi-racial, and 3.8% Hispanic. Overall, 35.2% reported having cancer-predisposing gene mutations. Mutation carriers were younger than those non-carriers (54.8 [SD 13.7] vs 60.3 [SD 12.8] years). After adjusting for age, carriers were more likely than non-carriers to have had breast MRI ( p<.001), colorectal cancer screening ( p=.039), ovarian cancer screening ( p=.043), and an FBSE ( p=.007) (Table). No statistically significant differences in mammogram (OR=1.50, 95% CI=0.55-2.30; p=.13), cervical cancer (OR=0.92, 95% CI=0.54-1.59; p=.77), PSA (OR=0.70, 95% CI: 0.26-1.88; p=.48), or lung cancer (OR=1.18, 95% CI=0.72-1.92; p=.51) screening between carriers and non-carriers. By race/ethnicity, cervical cancer screening (Hispanic 92%, White 90.6%, other/multiracial 80.7% and Black 76%; p=.002) and colorectal cancer screening (White 83.3%, other/multiracial 71.8%, Black 71.4% and Hispanic 66.6%; p=.004) differed significantly. Conclusions: In this diverse cohort of individuals at high risk for cancer, findings highlight an increased awareness and uptake of cancer screening, though varying by race/ethnicity. Cancer risk assessment clinics can be great avenues to provide comprehensive cancer screening and prevention strategies while addressing racial/ethnic screening disparities. [Table: see text]

Assessing patient eligibility at breast imaging for receipt of additional health screenings.

e23099 Background: Cancer screenings reduce morbidity and mortality. Breast cancer screenings are a well-known and utilized tool by many women. However, a suboptimal percentage of women are receiving additional eligible health screenings. A lack of health literacy and knowledge surrounding the importance of timely screenings contributes to low uptake. In this study, we aim to investigate the uptake of osteoporosis screening in women who presented for breast cancer screening. Methods: Data from all breast imaging patients of an urban, academic breast imaging center from January 2020-July 2023 was extracted from the EMR. Eligibility for osteoporosis screening was determined through clinical data query and the National Osteoporosis Foundation. Data variables such as race, primary language, and whether eligible patients underwent an osteoporosis screening were analyzed. A chi-square analysis was performed to determine the significance of these results. Results: A total of 56,945 patients presented to the breast imaging center between July 2020-July 2023. Of those patients, 22,443 (42.6%) were aged 65 and older indicating eligibility for a DEXA scan. 61% of these patients who were eligible for a DEXA scan received at least one scan, while 38.9% of them who met criteria did not receive a scan. Within racial groups, the Hispanic population had the highest uptake with 2318 (68.8%), followed by African American 5624 (62.5%), Asian 508 (60.3%), White 6151 (58%), and Other 322 (51.5%). Within the identified primary language, 187 (70.57%) of the Bilingual, 1101 (66.7%) Spanish, Other (66.03%), English (59.9%) received a DEXA scan. Statistically significant results (p < 0.0001) indicated that bilingual patients were more likely to have a DEXA scan than English as primary language patients. The differences between demographics and receiving a DEXA scan were statistically significant for all analyses (p < .0001). Conclusions: The main variables that influence the decision of breast imaging patients to complete a DEXA scan are a non-White race and non-English primary language, possibly due to the presence of adequate interpretation services, culturally competent care, and available education material. Nearly 40% of patients who presented for breast cancer screening were eligible for a DEXA scan but did not receive one. This suggests the need for interventions to increase uptake. Pairing breast cancer screening services with osteoporosis screening can provide a potential opportunity to capture missed patients. Additionally, further studies are needed to assess the differences in disparities.

Cancer screening in sexual and gender minority populations: A systematic review and meta-analysis.

10540 Background: The sexual and gender minority (SGM) populations experience a greater cancer burden than their heterosexual or cisgender counterparts. Screening rates for cancer within this cohort are frequently suboptimal, highlighting notable deficiencies in screening recommendations. Inadequate culturally competent care and screening guidelines may contribute to delays in cancer diagnosis and treatment, ultimately impacting survival and quality of life. We sought to investigate the existing disparities in cancer screening among SGM populations. Methods: We conducted a systematic review and meta-analysis to assess the cancer screening rates in SGM. The SGM population included in this study were gays, lesbians, bisexuals, transgender men, and transgender women. Two reviewers conducted a systematic search of numerous databases, including PubMed, PsycINFO, and CINAHL, and then extracted relevant information from eligible studies. For this study, we conducted a meta-analysis using a random-effects model. Pooled estimates of the odds ratio were calculated for any combination of outcomes and population when at least two studies had relevant data. Study heterogeneity was assessed using I² statistics. Meta-regression, accounting for the study weight, year, and latitude, was performed on variables potentially associated with heterogeneity. Newcastle-Ottawa Scale was used to assess the quality of selected studies. Results: We analyzed data from a total of 60 eligible studies with 65,315 patients. Pooled analysis showed that sexual minority groups were at lower risk for cancer screening such as breast cancer screening (OR: 0.79, 95% CI, 0.75-0.82; Chi2=835.23; p<0.001; I2=97%), cervical cancer screening (OR: 0.62, 95% CI, 0.56-0.72; Chi2=926.23; p<0.001; I2=96%), colorectal cancer screening (OR: 0.51, 95% CI, 0.45-0.61; Chi2=3272.21; p<0.001; I2=98%), and prostate cancer screening (OR: 0.71, 95% CI, 0.63-0.82; Chi2=1282.92; p<0.001; I2=99%). The prevalence of lung cancer (p<0.001) and anal cancer screening (p<0.001) were also lower in sexual minority groups. The analysis also showed no small study effects (Egger test: 1.33; 95% CI: −5.42, −0.63; p=0.182). All the subgroups (geographical location, screening procedure, screening period) had high between-study heterogeneity. Conclusions: Our findings indicate that cancer screening rates for breast, cervical, colorectal, prostate, lung, and anal cell cancer are significantly lower in SGM populations and emphasize the urgent need for targeted interventions, culturally competent care, and inclusive screening guidelines to address these disparities. Understanding and addressing these issues are crucial for reducing delays in cancer diagnosis and improving survival and quality of life for SGM population. Further research and comprehensive strategies are warranted to bridge these gaps in cancer screening accessibility and uptake.

AI virtual patient navigation to promote re-engagement of U.S. inner city patients nonadherent with colonoscopy appointments: A quality improvement initiative.

100 Background: Colorectal cancer disparities loom large for underserved communities of color in the US where barriers to screening uptake can contribute to late-stage diagnosis and poor outcomes. Despite active outreach by skilled patient navigators (PN) at a NYC cancer center serving an ethnically minoritized and disadvantaged population, 59% (1,925/3,276) of patients either cancelled or did not show for their colonoscopy appointments in 2022. While PN re-engagement efforts led to 410 (21%) completing colonoscopy, 1,500 patients did not undergo potentially life-saving colon cancer screening that year. With the advent of conversational Artificial Intelligence (AI)-driven applications within health care offering a potential extension to a stretched workforce, our cancer center examined the use of an AI-based virtual patient navigator, MyEleanor, as part of a colorectal cancer screening quality improvement (QI) project. Methods: This QI project employed MyEleanor between Apr-Dec 2023 to target re-engagement of 2,400 patients nonadherent with colonoscopy appointments in 2022-2023. In place of human PNs, MyEleanor (a) called patients to discuss rescheduling, (b) assessed barriers to uptake, c) offered live transfers to clinical staff to reschedule, and d) provided procedure prep reminder calls. Evaluable outcomes included: (a) engagement with MyEleanor via identity confirmation, (b) live transfers accepted (actionable), (c) colonoscopy completion rate, and (d) patient volume, with (d) barriers to care, and (e) predictors of actionable engagement examined. Results: Over 8 months, 57% (1,368/2,400) of patients engaged with MyEleanor, with 58% (789) of this group, or 33% overall, accepting the live transfer. The completion rate for patients who did not show for initial appointment nearly doubled from 10% to 19% from 2022 to 2023 (pre to post-MyEleanor). Overall patient volume increased by 36%. Patients who engaged were a Mean age of 56.66 (41-79 yrs), female (66%), Hispanic (41%), Black (33%), English (73%) or Spanish (25%) speaking, and partnered (37%). Nearly one third reported at least two barriers to screening; top barriers included lack of perceived need (19%), time (18%), and MD encouragement (16%), medical mistrust (14%), and concerns about findings (13%) and cost (12%). Greater number of barriers predicted actionable engagement, (F(1366) = 354, p < 0.001), with Spanish-dominant patients and those declining to identify their race reporting nearly twice the number of barriers, F(1366) = 138.98 and F(1366) = 5.17, p < 0.001, respectively). Conclusions: This project demonstrates high potential of an AI patient navigator in helping to overcome patient attrition that can lead to colon cancer disparities while improving patient volume. Next phase of the project will examine impact on patient prep adherence, staff burden, and revenue.

Cervical Cancer Screening Uptake Inequality

Cervical Cancer Screening Uptake Inequality

Implementing fragmentomics into real world screening interventions to evaluate clinical utility among individuals with elevated risk for lung cancer (FIRSTLUNG) L301.

TPS11189 Background: To optimize the impact of lung cancer screening at the healthcare system level, additional tools are needed to increase the benefits of screening. While low-dose computed tomography (LDCT) has been shown to improve lung cancer detection and reduce mortality, it is not without its risks, such as radiation exposure, false-positive results, and unnecessary interventions often leading to complications. The additional complexity of lung cancer screening is the subpar adherence to LDCT for eligible individuals, which undermines the benefits of screening. Therefore, there is a need for alternative non-invasive methodologies that exploit our understanding of the biology of cancer pathogenesis. This clinical utility study aims to observe how a non–invasive blood-based test impacts physician behavior and LDCT utilization. Methods: FIRSTLUNG 301 (NCT06145750) is a prospective, cluster randomized controlled trial (RCT) to observe the impact of the DELFI Lung cancer screening test on lung cancer screening utilization in primary care practices. Enrolled practices must meet the eligibility criteria of having a minimum of 50 actively engaged individuals in the practice eligible for lung cancer screening per the 2021 USPSTF criteria. These practices will be randomized 1:1:2 to Arm A1 (control), Arm A2 (control), or Arm B (intervention). Arm A practices will be randomized 1:1 into two groups (A1:A2) to observe the standard of care for lung cancer screening. Practices in A1 will be observed; practices in A2 will receive standard education on lung cancer screening for CME credit. Randomizing within Arms A1 and A2 aims to delineate the impact standard lung cancer screening education may have on utilization. Arm B (intervention) practices will receive education and have access to order the blood-based test for screen-eligible individuals that remained unscreened. The primary study endpoint is the proportion of practice-identified lung cancer screen-eligible individuals receiving a screening CT order and scan during the study period in the entirety of Arm A (control) versus Arm B (intervention). This RCT aims to understand the utilization and impact on lung cancer screening uptake after the DELFI blood-based test intended to inform clinical guidelines and policies focused on improving patient care and health outcomes. Progress: The study was initiated on October 31, 2023, with practice randomization. As of February 2024, the study is open for enrollment with an estimated primary study completion date of December 2025. Clinical trial information: NCT06145750 .

Efficacy of a culturally tailored screening campaign to tackle cervical cancer disparities among Hispanic patients.

e13697 Background: Cultural barriers have been identified as drivers of cervical cancer disparities. Hispanic patients specifically experience a higher incidence of cervical cancer and are more likely to be diagnosed at advanced stages than non-Hispanic White patients, mediated by multiple factors including cultural perceptions. To tackle cultural barriers in cervical cancer screening, this study assessed the efficacy of a community-based media campaign to increase Pap tests within a predominantly Hispanic community in east Los Angeles (LA). Methods: The campaign was implemented through a collaboration of local community members, design and communication experts, and cancer researchers. Prior to campaign design, focus groups were conducted with at-risk Hispanic women aged 18-45. Learnings from these focus groups and additional study of the visual culture of east LA led to selection of the jacaranda tree, which blooms for a short time in LA each spring, as a visual cue to pursue screening. This imagery was accompanied by a scheduling phone number and messaging (“It’s time.” and “You can prevent cervical cancer.”) in Spanish and English. Campaign materials were displayed on bus benches, billboards, and light post banners throughout east LA. To analyze campaign efficacy, intercept surveys were conducted from 2015-2018 by trained interviewers at locations throughout the community. In their preferred language, female participants (n=770) were asked standardized questions assessing campaign recall, message interpretation, and likelihood of scheduling a Pap test after viewing the campaign. Results: Among participants, mean age was 47.4 years, 88.7% primarily spoke Spanish at home, 25.2% were uninsured, 80.6% had not been vaccinated against HPV, and 12.5% had not had a Pap test in the last 3 years. 25.7% of participants recalled having seen campaign materials prior to survey, with 71.7% interpreting the message as a call to prevent and/or get screened for cervical cancer. 89.3% of participants stated that they were Likely or Extremely Likely to schedule a Pap test after viewing the campaign, including 87.2% of those who had not had a Pap test in the last 3 years. Conclusions: These findings support the efficacy of a community-based strategy to increase cervical cancer screening. This campaign showed high screening intent in a sample of participants who were disproportionately uninsured (25.2% v. 8.5% overall in the US in 2018), with similar efficacy among those who were overdue for recommended screenings. These results emphasize the benefit of culturally tailored messaging to improve screening uptake within underserved populations.

Differences in shared decision-making and prostate cancer screening by sexual orientation and race/ethnicity.

10525 Background: There are well-documented disparities among racial and sexual minorities in prostate cancer screening uptake and shared-decision making (SDM) conversations. However, it is unclear how racial/ethnic identity and sexual orientation interact to affect prostate-specific antigen (PSA) testing uptake. Methods: Data came from the 2018-2022 Behavioral Risk Factor Surveillance Survey (BRFSS). Outcomes were survey responses to questions about engagement in SDM and PSA testing uptake. The sample included 88,365 heterosexual (HS) men and 2,562 sexual minority (SM) men ages 55 to 69. Data were stratified by race/ethnicity and survey-weighted logistic regression models analyzed the association between sexual orientation and outcomes. Models controlled for age, relationship status, education, household income, insurance status, having a usual source of care, and region. Results: White SM men were more likely to have discussed disadvantages of PSA testing with their healthcare provider [odds ratio (OR)=1.407; p<0.001] and to have undergone PSA testing [OR=1.320; p<0.001] compared to White HS men. Asian SM men were more likely to have had discussions about PSA testing [OR=4.470; p<0.05]; to have discussed advantages [OR=4.596; p<0.05]; to have been recommended PSA testing [OR=4.836; p<0.05] and to have undergone PSA testing [OR=4.401; p<0.001] compared to Asian HS men. Black SM men were more likely to undergo screening because of an issue or a reason besides routine screening [OR=1.073, p<0.05] compared with Black HS men. Hispanic SM men were more likely to have undergone screening as part of a routine checkup [OR=4.2, p<0.001] compared with Hispanic HS men. There were no sexual orientation differences in PSA screening or SDM among American Indian or Native Alaskans. Conclusions: Differences in PSA testing uptake and SDM by sexual orientation vary by race/ethnicity. Further research is needed to study the factors affecting PSA testing uptake and SDM among sexual minority men of different racial/ethnic groups. [Table: see text]

A 'smear campaign' against patient-excluded policy changes: a reflection on the language used in cervical screening programmes.

Cervical screening has transformed the diagnosis of cervical cancer. However, uptake within the national screening programme is not uniform across demographics. This raises the question of whether medical language, which conveys essential information but also shapes attitudes towards engaging with healthcare, is part of the problem. The term "smear test" has been used for generations and is embedded in colloquial and medical vocabulary. However, there is a danger that the phrase may conjure images of an unpleasant or even reckless ordeal, potentially contributing to unnecessary patient anxiety. To evaluate patient attitudes towards the terms "cervical smear" and "cervical brush". Female participants from a single GP surgery were randomly sampled. Data from questionnaires were then subjected to thematic analysis. Half of patients interviewed did not feel either term would significantly influence cervical screening uptake. Equal numbers of patients expressed an overall preference for each of the two terms, and the remaining 28% expressed no preference. Qualitative data revealed some patients favoured the familiarity of the term "cervical smear", and others preferred the descriptive accuracy of "cervical brush". It is imperative to consult target groups and use inclusive language that minimises stigmatising or negative connotations. Modifying language alone is unlikely to remedy the current access barriers in UK cervical screening. Instead, a multifaceted approach that also targets education and addresses systemic issues could offer a more sustainable strategy. Ultimately, prioritising a patient-centred approach could improve access to life-saving screening.

Co-development of breast cancer health promotion educational materials for ethnically diverse women working with hairdressing and beauty salons: BELONG study.

Improved screening uptake is essential for early breast cancer detection, women's health and reducing health disparities. However, minority ethnic and deprived communities often face lower breast cancer screening rates and limited access to culturally tailored educational materials. A recent review found limited culturally tailored materials for breast cancer education. To investigate the culturally appropriate interfaces and preferences of salon staff in educating their clients about breast cancer METHOD: We used a two-stage approach, following the Double Diamond framework; discover and define phases. Relevant breast cancer materials (i.e., based on cultural appropriateness, English language presentation, and alignment with the UK context) were assessed using the Suitability Assessment of Materials (SAM) toolkit. Interviews with ethnically diverse salon staff provided insights into their needs and preferences for client education materials. Thematic analysis was applied to interview transcripts. Cultural appropriateness was evident in 9/14 (64%) of the materials identified (e.g., targeting black ethnicities with positive representations). Of those, six of them demonstrated an overall SAM rating of 76% ("Superior"). Thematic analysis of interviews identified seven key themes, including the importance of engagement strategies, education and awareness for health promotion, salon staff's role, preferred training methods, supportive materials, inclusivity, representation, and participant satisfaction. This study highlights the SAM toolkit's role in selecting suitable educational materials for breast cancer prevention. The research offers prospects for improving breast cancer awareness in ethnically diverse communities and addressing healthcare access disparities, with salon hairdressers emerging as crucial advocates for health promotion.

Update on the practice of premarital screening for sickle cell traits in Africa: a systematic review and meta-analysis

BackgroundScreening for sickle cell traits before marriage or producing children is one of the outstanding preventive measures for sickle cell disease (SCD).The disease is a collection of inherited blood disorders that impact millions globally, with a predominant 75% occurrence in the sub-Saharan region. With increasing burden of SCD on the continent amidst a cost effective prevention method, no study has systematically reviewed or presented meta-analytic uptake or practice of premarital sickle cell trait screening.MethodsThis review systematically explored the uptake or practice of premarital genotype screening in Africa. We searched PubMed and Scopus databases for African studies on premarital screening for sickle cell traits.ResultsOur results indicate that the pooled uptake of premarital sickle cell trait screening in Africa is 47.82% (95% CI: [46.53–49.11]; I2: 98.95% [98.74–99.13]). Our review observed, a significant relationship between the awareness of sickle cell disease and the uptake of genotype screening; F(1, 13) = 12.04, p = 0.004). The model explained approximately 48.08% of the variation in genotype screening (R² = 0.4808) and predicted a 0.729 increase in the likelihood of genotype screening uptake for every unit rise in sickle cell disease awareness (β = 0.729, p = 0.004). Additionally, Pearson correlation (r = 0.6934) indicated a moderately strong positive correlation between the two variables.ConclusionWith over 75% of the global burden of sickle cell disease domiciled in Africa, the continent cannot overlook the cost of hemoglobinopathies. The uptake of sickle cell traits screening is suboptimal across the continent. To achieve the mandate of sustainable development goal number (3); to end preventable deaths of newborns and children under 5 years of age by 2030, there is need to intensify campaigns on premarital genetic screening through education and other health promotion tools.

Effectiveness of couple education and counseling on uptake of cervical cancer screening among women in Southern Ethiopia: a cluster randomized trial

Cervical cancer is a major public health problem worldwide. Women die of the disease due to low early screening practices and its detection at advanced stages particularly in developing countries. Therefore, this study aimed to determine the effectiveness of couple education and counseling on the uptake of cervical screening among women. The study employed random allocation of 16 clusters into two study arms. A total of 288 women participated in the study. Structured home-based education and counseling were provided to the intervention group, while the control group received standard of care. Surveys were completed at baseline and end line. This study demonstrated that the proportion of women who had been aware of cervical cancer and screening grew from 22.9 to 100%, participants’ mean knowledge scores showed improvement from 3.18 to 11.99, and cervical screening uptake increased from 2.1% to 72.5% in the intervention group (p < 0.001). Also, the difference in differences of screening uptake between the study groups was statistically significant (p = 0.021).The study shows the effectiveness of the intervention package in improving the uptake of cervical screening in the study setting. Therefore, we recommend that creating awareness, increasing knowledge, and improving women’s perceptions through structured home-based couple education and counseling is important to improve cervical screening uptake among the target women.

Knowledge and Awareness of Spinal Muscular Atrophy in Pre-Marital Health Screenings: A Cross-Sectional Study

Background and Purpose: Early diagnosis of Spinal Muscular Atrophy (SMA) is crucial. This study assesses the awareness and attitudes toward SMA screening among individuals preparing for marriage. Methods: This cross-sectional study was conducted in three family health centers in the central district of XXX from June to September 2023. A researcher-designed 15-item instrument was utilized to collect demographic data and assess knowledge and attitudes regarding SMA among participants aged 18-65, excluding those with a diagnosis of mental retardation. Results: The study was participated in by 197 individuals, with an average age determined to be 29.45±7.48. The proportion of those supporting the implementation of SMA screening was 84.8% (n=167), while the intention to undergo the test was identified at 72.6% (n=143). A significant relationship was found between the willingness to be tested and variables such as the level of education, absence of disabled close relatives, not considering SMA to be genetically inherited, finding screenings appropriate, the perceived impact of test results on marriage, and the belief that screening could not be conducted after marriage. Conclusion: While most recognized SMA's severity, there's a notable deficit in understanding its preventability, suggesting the need for targeted educational interventions to enhance genetic screening uptake.

Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study

Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value < 0.05 was considered significant. A total of 354 study participants were included in the present study. The mean age of participants was 31.0 ± 11.8 years. The majority of study participants (67.5%, n = 239) were aware of BC screening. However, only (35.3%, n = 125) reported to have ever practised BC screening. Breast self-examination was the most (16.4%, n = 58) frequently used method for BC screening among study participants. Lack of knowledge of all methods of BC screening was the barrier that was perceived by the vast majority (60.2%, n = 213) of the study participants. Having low family income was the only predictor of failure to practice BC screening. In this study, most of the women were aware of BC, however, few of them had undergone breast cancer (BC) screening at the time of the interview. The study also found that the main barrier to BC screening was the lack of knowledge about BC among the study participants. Immediate measures are necessary to increase women's awareness of BC. Such as community sensitization on the importance of screening, can help improve the uptake of BC screening and the early detection of BC.

Understanding Washington State’s Low Uptake of Lung Cancer Screening in Two Steps: A Geospatial Analysis of Patient Travel Time and Health Care Availability of Imaging Sites

BackgroundEarly detection of lung cancer reduces cancer mortality; yet uptake for lung cancer screening (LCS) has been limited in Washington State. Geographic disparities contribute to low uptake, but do not wholly explain gaps in access for underserved populations. Other factors, such as an adequate workforce to meet population demand and the capacity of accredited screening facility sites must also be considered. Research QuestionWhat proportion of the eligible population for LCS have access to LCS facilities in Washington State? Study Design and MethodsWe used the enhanced two-step floating catchment (E2SFCA) model to evaluate how geographic accessibility in addition to availability of LCS imaging centers contribute to disparities. We used available data on radiologic technologist volume at each American College of Radiology (ACR) accredited screening facility site to estimate each site’s capacity to meet potential population demand. Spearman rank correlation coefficients of the spatial access ratios (SPARs) were compared with the 2010 Rural-Urban Commuting Area (RUCA) codes and Area Deprivation Index (ADI) quintiles to identify characteristics of populations at risk for lung cancer with greater and lesser levels of access. ResultsA total of 549 radiologic technologists were identified across the 95 ACR accredited screening facilities. We observed that 95% of the eligible population had proximate geographic access to any ACR facility. However, when we incorporated the E2SFCA method, we found significant variation of access for eligible populations. The inclusion of the availability measure attenuated access for most of the eligible population. Furthermore, we observed that rural areas were substantially correlated and areas with greater socioeconomic disadvantage were modestly correlated with lower access. InterpretationRural and socioeconomically disadvantaged areas face significant disparities. The E2SFCA models demonstrated that capacity is an important component and how geographic access and availability jointly contribute to disparities in access to LCS.