United States Preventive Services Task Research Articles

Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study

BackgroundThe United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion.MethodsWe used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™.ResultsWe completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic.ConclusionIf the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.

Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision Making

The 2018 United States Preventive Services Task Force recommendations endorsed shared decision-making (SDM) for men aged 55-69, encouraging consideration of patient race/ethnicity for prostate-specific antigen (PSA) screening. This study aimed to assess whether a proxy SDM variable modified the effect of race/ethnicity on the likelihood of PSA screening. A cross-sectional analysis of men between 55 and 69 years, who responded to the PSA screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated SDM were used to test whether SDM modified the effect of race/ethnicity on screening. Out of a weighted sample of 26.8 million men eligible for PSA screening, 25.7% (6.9 million) reported PSA screening. In adjusted analysis, estimated SDM was a significant predictor of PSA screening (aOR:2.65, 95%CIs: 2.36-2.98, p<0.001). The interaction between race/ethnicity and estimated SDM on the receipt of PSA screening was significant (pint=0.001). Among those who did not report estimated SDM, both non-Hispanic Black (OR: 0.77, 95%CIs: 0.61-0.97, p=0.026) and Hispanic (OR: 0.51, 95%CIs: 0.39-0.68, p<0.001) men were significantly less likely to undergo PSA screening than non-Hispanic White men. On the contrary, among respondents who reported estimated SDM, no race-based differences in PSA screening were found. While much disparities research focuses on race-based differences in PSA screening, research on strategies to mitigate these disparities is needed. SDM might attenuate the effect of race/ethnic disparities on the likelihood of PSA screening.

Leveraging seasonality and timing to optimize pediatric weight management interventions: Novel directions for future research.

National estimates suggest that more than 35% of American children, ages 2-19years, are overweight or obese, which increases their risk for weight-related comorbidities including diabetes, cancer, cardiovascular disease risk factors, depression, and anxiety. While obesity prevention is most cost-effective, for youth with existing obesity, the United States Preventive Services Task Force recommends ≥26h of comprehensive lifestyle intervention over 6-12months. This include standard behavioral therapy, dietary counseling, and an emphasis on physical activity. Although such programs are effective in reducing weight status, there are many barriers to completing these programs. A novel consideration for both the prevention and treatment of childhood obesity is the recognition that the timing of intervention, both duration and time of the year, can impact family engagement and intervention effectiveness. This paper discusses the potential of targeting high-risk periods for weight gain and offering brief behavioral intervention, in hopes of inspiring research on novel approaches to the prevention and treatment of childhood obesity.

Changes in Prostate-specific Antigen Screening after the 2018 United States Preventive Services Task Force Recommendations and Through the COVID-19 Pandemic

We analyzed trends in prostate-specific antigen (PSA) screening for prostate cancer, with a focus on the impact of the 2018 US Preventive Services Task Force (USPSTF) recommendations and the COVID-19 outbreak. Using National Health Interview Survey data, we performed difference-in-difference (DID) analyses to examine the PSA screening trend for men aged 55–69 yr, the target population in the 2018 USPSTF update, with men aged >69 yr included as the reference and adjustment for sociodemographic factors. We found that PSA screening increased for men aged 55–69 yr (+4.6%, 95% confidence interval [CI] 1.7–7.5%) or >69 yr (+6.5%, 95% CI 2.7–10.4%) in 2019 (after the 2018 recommendations) in comparison to 2015. There was a decrease in PSA screening for men aged 55–69 yr in 2021 in comparison to 2019 (after the COVID-19 outbreak in 2020) of −3.1% (95%CI −0.4% to −5.8%). Adjusted DID analysis revealed no significant variations in the rate of change in PSA screening between the two age groups following both events. Despite its observational nature, our design mitigates major challenges in inferring causal relationships. Our results suggest a causal relationship between the 2018 screening guidelines and an increase in screening rates for men aged 55–69 yr. Conversely, they also indicate that preventive care disruptions related to COVID-19 may have induced deceleration or potentially reversal of these advances. Patient summaryWe used data from a large national survey to study the rate of prostate-specific antigen (PSA) screening for prostate cancer in the USA in response to the 2018 United States Preventive Services Task Force recommendations and to the COVID-19 pandemic. We found an increase in PSA screening in 2019 among men aged 55–69 yr, the target population in the 2018 recommendations, as well as men aged >69 yr. However, this increase was reduced after the COVID-19 outbreak. It remains to be seen how PSA screening continues to change as the world recovers from COVID-19.

Study protocol for the ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention

PurposeTo examine the effectiveness, cost-outcome, equity, scalability, and mechanisms of the Reach Out, Stay strong, Essentials for mothers of newborns (ROSE) postpartum depression prevention (PPD) program as universal versus selective or indicated prevention. BackgroundThe United States Preventive Services Task Force (USPSTF) currently recommends PPD prevention for pregnant people at risk of PPD (i.e., selective/indicated prevention). However, universal prevention may be more scalable, equitable, and cost-beneficial. DesignEffectiveness of ROSE for preventing PPD among people at risk is known. To assess ROSE as universal prevention, we need to determine the effectiveness of ROSE among all pregnant people, including those screening negative for PPD risk. We will enroll 2320 pregnant people, assess them with commonly available PPD risk prediction tools, randomize everyone to ROSE or enhanced care as usual, and assess ROSE as universal, selective, and indicated prevention in terms of: (1) effectiveness (PPD prevention and functioning), (2) cost-benefit, (3) equity (PPD cases prevented by universal prevention that would not be prevented under selective/indicated for minority vs. non-Hispanic white people), (4) quantitative and qualitative measures of scalability (from 98 agencies previously implementing ROSE), (5) ROSE mechanisms across risk levels. We will integrate results to outline pros and cons of the three prevention approaches (i.e., universal, selective, indicated). ConclusionThis will be the first trial to assess universal vs. selective/indicated PPD prevention. Trial design illustrates a novel, efficient way to make these comparisons. This trial, the largest PPD prevention trial to date, will examine scalability, an understudied area of implementation science.

Factors Associated with Guideline Concordant Clinician Counseling about Low-Dose Aspirin to Prevent Preeclampsia in Nulliparous Patients.

The primary aim of this study was to examine the United States Preventative Services Task Force (USPSTF) guidelines concordant low-dose aspirin (LDA) counseling and factors associated with counseling in nulliparous birthing individuals. We conducted a retrospective cohort study of nulliparous birthing individuals who delivered between January 1, 2019 and June 30, 2020 and received prenatal care at the Duke High Risk Obstetrical Clinics (HROB). All nulliparous patients over 18 years old who established or transferred care to HROB by 16 weeks, 6 days were included in the analysis. We excluded patients with more than two previous first-trimester pregnancy losses, multiple gestation, a known contraindication to LDA, initiation of LDA prior to their prenatal care, or documented medical history of coagulation disorder. Bivariate associations between demographic/medical characteristics and our primary outcome, receipt of counseling (yes/no), were assessed using two-sample t-tests for continuous variables and chi-square or Fisher's exact test for categorical variables. Factors significantly associated with the primary outcome (p < 0.05) were entered into the multivariable logistic regression model. Among 391 birthing individuals included in the final analysis cohort, 51.7% of eligible patients received guideline consistent LDA counseling. Factors associated with increased odds of LDA counseling were advanced maternal age (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 1.01-1.09), Black race compared with White race (aOR:1.75, 95% CI: 1.03-2.98), chronic hypertension (aOR: 4.17, 95% CI: 1.82-9.55), and obesity (aOR: 5.02, 95% CI: 3.12-8.08). Approximately half of all nulliparous birthing individuals had appropriately documented LDA counseling. The USPSTF guidelines on LDA for preeclampsia risk reduction are complex, which may lead to ineffective provider adherence. Efforts to simplify guidelines and improve LDA counseling are vital to ensuring this low-cost, evidence-based preeclampsia prevention is used in a consistent and equitable manner. · A total of 51.7% of eligible patients received guideline consistent LDA counseling.. · Advanced maternal age , body mass index > 30, Black race, and chronic hypertension associated with increased odds of counseling.. · Among patients most likely to be counseled, high numbers did not receive LDA counseling..

Current Progress of COPD Early Detection: Key Points and Novel Strategies.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, with approximately 70% to 80% of adults with COPD being undiagnosed. Patients with undiagnosed COPD are at increased risk of poor outcomes and a worsened quality of life, making early detection a crucial strategy to mitigate the impact of COPD and reduce the burden on healthcare systems. In the past decade, increased interest has been focused on the development of effective strategies and instrument for COPD early detection. However, identifying undiagnosed cases of COPD is still challenging. Both screening and case-finding approaches have been adopted to identify undiagnosed COPD, with case-finding being recommended by the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline and the updated United States Preventive Services Task Force (USPTF) recommendation. Nonetheless, the approaches, criteria, and instruments used for early detection of COPD are varied. However, advances in the taxonomy and risk factors of COPD are continuously being investigated. It is important to continuously assess the current state of knowledge on COPD early detection, given the challenges associated with identifying undiagnosed COPD. This review aims to highlight recent advances in early detection of COPD. To discuss the current challenge and opportunity in COPD early detection, providing an overview of existing literature on COPD case-finding strategies, including the approaches, criteria for subjects, and instruments. The review also summarizes the current progress in COPD case-findings and proposes a COPD case-finding flowchart as an efficient method for identifying at risk COPD patients.

131-OR: Glycemic Measures in Childhood as Predictors of Future Diabetes-Related Microvascular Complications

The United States Preventive Services Task Force recently questioned the benefits of risk-based screening for prediabetes/T2D in asymptomatic children with overweight/obesity due to lack of long-term health outcomes data. We examined associations of HbA1c and 2-hour post-load plasma glucose (2-hr PG), obtained during childhood (5 - &amp;lt;18 years) in a longitudinal study in an American Indian community (1965-2007), with future albuminuria [albumin creatinine ratio (ACR) ≥ 30 mg/g], severe albuminuria (ACR ≥ 300 mg/g), and retinopathy (at least one microaneurysm or hemorrhage or proliferative retinopathy on direct ophthalmoscopy). We compared the performance of childhood glycemic measures in predicting these complications using area under the ROC curve (AUC). In children without T2D at baseline, higher HbA1c (HR=3.09 per 1%, 95% CI: 1.17-8.22) and 2-hr PG (HR= 1.48 per 1 mmol/L, 95% CI: 1.31-1.67) significantly increased retinopathy risk. Children with T2D based on baseline HbA1c had the highest incidence of albuminuria, severe albuminuria, and retinopathy compared to those with prediabetes and normal HbA1c levels. AUCs for HbA1c, 2-hr PG, or FPG were not significantly different (Figure). Higher levels of glycemia in childhood associated with future microvascular complications demonstrating the utility of screening tests performed in high-risk children in predicting long-term health outcomes. Disclosure L.Vazquez: None. E.Vazquez arreola: None. R.L.Hanson: None. M.Sinha: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases

1277-P: Prediction of HbA1c Test Eligibility in Emergency Department

Introduction: Diabetes screening using best practice advisory (BPA) alerts integrated into the emergency department (ED) workflow may efficiently identify at-risk patients disproportionally affected by diabetes. The objectives of this study were to 1) validate a BPA algorithm informed by the American Diabetes Association (ADA) screening criteria using elements from the electronic medical record (EMR) to identify eligible patients for hemoglobin A1c (HbA1c) testing, and 2) compare the characteristics of the ADA-based algorithm with one informed by the United States Preventative Services Task Force (USPSTF) recommendations. Methods: This cross-sectional study involved adults admitted to the University of Illinois Health ED in May 2021 with labs ordered (n=2963). Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) estimated the BPA algorithm’s ability to correctly identify patients eligible for diabetes screening using manual EMR chart review as the reference standard. Receiver operator characteristic (ROC) curves and area under the curve (AUC) were calculated to compare ADA and USPSTF-informed algorithms. Results: The sensitivity, specificity, PPV, and NPV of the ADA model were 0.70 (95% CI: 0.66-0.75), 0.91 (0.90-0.92), 0.76 (0.73-0.79), and 0.88 (0.86-0.89), respectively. Compared to the ADA model, the USPSTF model’s sensitivity was worse (0.25 (0.22-0.27)) and specificity was slightly higher (0.94 (0.93-0.95)), though PPV remained similar (0.75 (0.71-0.79)) and NPV was lower (0.64 (0.62-0.66)). The ROC AUC for the ADA and USPSTF-based models were 0.91 (0.89-0.93) and 0.86 (0.84-0.89), respectively. Conclusion: Despite moderate to low sensitivity, the PPVs and large AUCs are acceptable due to the high prevalence of at-risk populations presenting to the ED. Findings suggest that a BPA algorithm informed by the ADA guideline is an adequate tool to identify eligible patients for diabetes screening in the ED, especially given its ease of workflow integration. Disclosure M.Smart: None. J.Lin: Research Support; Novo Nordisk, Xeris Pharmaceuticals, Inc. T.Lee: None. B.T.Layden: Consultant; Bayer Inc. Y.Eisenberg: None. K.K.Danielson: None. A.Kong: None. Funding Novo Nordisk (G2111)

Safety and efficacy of Vitamin C, Vitamin E, and selenium supplementation in the oncology setting: A systematic review.

With rising rates of complementary and alternative medicine (CAM) use, the exploration of CAM integration into oncology treatments is becoming increasingly prevalent. Antioxidants have been proposed as potentially beneficial to prevent or treat cancer. However, evidence summaries are limited, and the United States Preventive Services Task Force has recently recommended the use of Vitamin C and E supplementation for cancer prevention. Thus, the objective of this systematic review is to evaluate the existing literature on the safety and efficacy of antioxidant supplementation in oncology patients. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using prespecified search terms in PubMed and CINAHL. Two reviewers independently reviewed titles, abstracts, and full-text articles, with a third reviewer resolving conflicts, before the included articles underwent data extraction and quality appraisal. Twenty-four articles met the inclusion criteria. Of the included studies, nine evaluated selenium, eight evaluated Vitamin C, four evaluated Vitamin E, and three of these studies included a combination of two or more of these agents. The most frequently evaluated cancer types included colorectal cancer (n = 4), leukemias (n = 4), breast cancer (n = 3), and genitourinary cancers (n = 3). Most of the studies focused on the antioxidants' therapeutic efficacy (n = 15) or their use in protecting against chemotherapy- or radiation-induced side effects (n = 8), and one study evaluated the role of an antioxidant in protection against cancer. Findings were generally favorable among the studies, and adverse effects of supplementation were limited. Furthermore, the average score for all the included articles on the Mixed Methods Appraisal Tool was 4.2, indicating the high quality of the studies. Antioxidant supplements may provide benefits in reducing incidence or severity of treatment-induced side effects with limited risk for adverse effects. Large, randomized controlled trials are needed to confirm these findings among various cancer diagnoses and stages. Healthcare providers should understand the safety and efficacy of these therapies to address questions that arise in caring for those with cancer.

Uptake of colorectal cancer screening after mailed fecal immunochemical test (FIT) outreach in a newly eligible 45–49-year-old community health center population

PurposeWe assessed fecal immunochemical test (FIT) uptake following a mailed FIT intervention among 45–49-year-olds newly eligible for colorectal cancer (CRC) screening based on 2021 United States Preventive Services Task Force screening recommendations. We also tested the effect of an enhanced versus plain mailing envelope on FIT uptake.MethodsIn February 2022 we mailed FITs to eligible 45–49-year-olds at one Federally Qualified Health Center (FQHC) clinic. We determined the proportion who completed FITs within 60 days. We also conducted a nested randomized trial comparing uptake using an enhanced envelope (padded with tracking label and colored messaging sticker) versus plain envelope. Finally, we determined the change in CRC screening by any modality (e.g., FIT, colonoscopy) among all clinic patients in this age group (i.e., clinic-level screening) between baseline and 6 months post-intervention.ResultsWe mailed FITs to 316 patients. Sample characteristics: 57% female, 58% non-Hispanic Black, and 50% commercially insured. Overall, 54/316 (17.1%) returned a FIT within 60 days, including 34/158 (21.5%) patients in the enhanced envelope arm versus 20/158 (12.7%) in the plain envelope arm (difference 8.9 percentage points, 95% CI: 0.6–17.2). Clinic-level screening among all 45–49-year-olds increased 16.6 percentage points (95% CI: 10.9–22.3), from 26.7% at baseline to 43.3% at 6 months.ConclusionCRC screening appeared to increase following a mailed FIT intervention among diverse FQHC patients aged 45–49. Larger studies are needed to assess acceptability and completion of CRC screening in this younger population. Visually appealing mailers may improve uptake when implementing mailed interventions.Trial registration The trial was registered on May 28, 2020 at ClinicalTrials.gov (identifier NCT04406714).

National lung cancer screening rates among women veterans within the Veterans’ Health Administration.

1543 Background: Lung cancer is the number one cause of cancer related death among women in the United States. United States Preventive Services Task Force (USPTF) lung cancer screening (LCS) guidelines recommend annual low dose computed tomography (LDCT) among high-risk populations. The data specifically on women veterans is sparse so we retrospectively examined LCS rates among women veterans within the VHA. Methods: Women veterans ages 50-80, current or former (quit within 15 years) smokers from 2013- 2021 were identified through the VA corporate data warehouse (CDW). Captured characteristics included: demographics, smoking history, and cancer screening history (lung, breast, cervical). Data was analyzed using R Studio software. Results: Women veterans with a history of smoking (n=40,299) tended to be aged ≥60, white (66%), single (69%), unemployed (64%), urban dwelling (67%), and residing in Southeast U.S. (31%). Overall, cancer screening rates among women veterans was low (9% lung; 27% breast; 21% cervical). Of the women not screened for lung cancer (91%; n=36,837), 11% (n=4, 016) had a personal history of cancer. While pack-year history was not documented for the vast majority (92%), 7% (n= 2, 729) reported a &gt;30 pack-year smoking history (guideline at the time). Of these &gt;30 pack-year smokers, 88% (n=2,418) were not screened for lung cancer. Other significant demographic predictors of increased LCS rates included Southeast Veterans Integrated Service Network (VISN region) and comorbidities such as bipolar disorder and diabetes likely due to increased exposure to healthcare. Conclusions: LCS rates, as well as breast and cervical, among women veterans within the VHA is low. The lack of documented pack-year history among women veterans with a history of smoking is concerning. Increased documentation of pack-year history may aid in identifying women for LCS. Efforts are ongoing nationally to implement an equitable centralized LCS program for all veterans and as part of that effort the Birmingham VA Health Care System has utilized their Lung precision Oncology program (LPOP) funding to pilot a structured lung cancer screening program within our Women’s Health Clinic in 2022.

Patient navigation for lung cancer screening in an urban safety-net system: A pragmatic randomized clinical trial.

10577 Background: Although low-dose computed tomography (LDCT)-based lung cancer screening (LCS) can decrease lung cancer mortality in high-risk individuals, it may be a complex and time-intensive process that poses challenges to patients, particularly those from minority, under- and uninsured populations. We conducted a pragmatic randomized controlled trial of telephone-based navigation for LCS within an integrated, urban safety-net healthcare system (Parkland Health, Dallas, Texas). Methods: Patients eligible for LCS based on United States Preventive Services Task Force 2013 Guidelines were randomized (1:1) to usual care with or without phone-based navigation. Following a structured protocol, navigators made systemic contact with patients to provide appointment reminders, share information and resources, assess barriers to LCS, and address smoking cessation. The primary endpoint was completion of the first three consecutive steps (eg, 3 annual LDCTs or LDCT, other imaging, biopsy) in a patient’s LCS process. We also explored differences in completion of LCS steps in navigation and usual care groups according to patient characteristics using chi-square test. Results: Patients (n=447) were randomized to phone-based navigation (n=225) or usual care (n=222) between February 2017 and February 2019. Mean patient age was 62 years, 46% were female, and 69% were racial-ethnic minorities. There was no significant difference in completion of the first three steps of the LCS algorithm (12 vs. 9%; P=0.3) between arms. Completion of LCS steps was not impacted by navigation among different subgroups, including age (&lt;65 vs. ≥65 years), gender (male vs. female), race/ethnicity (non-hispanic white vs. racial minorities), and comorbidity status (Charlson Comorbidity Index &lt;5 vs. ≥5). A key reason for step non-completion was lack of order placement. In the navigation arm, 368 of expected 675 steps (55%) were ordered, and in the usual care arm, 344 of expected 666 steps (52%) were ordered. Despite low three-step completion rates overall, the majority (&gt;75%) of LCS algorithm steps were completed when ordered by their clinical team(Table). In exploratory univariable analysis, completion rates for ordered steps were 86% for navigation and 79% for usual care ( P=0.03). Conclusions: In this study, lack of order placement was a key reason for incomplete LCS steps. When orders were placed, navigated patients had higher rates of completion. Clinical team education and enhanced EHR processes to simplify order placement, coupled with patient navigation, may increase LCS uptake and completion in safety-net healthcare systems. Clinical trial information: NCT02758054 . [Table: see text]

An RCT of Two Interventions to Usual Care For Increasing Cervical Cancer Screening

Purpose: Rural women have increased incidence and mortality from cervical cancer (CC) compared to urban women indicating a lack of cervical cancer screening (CCS), an important component of CC control. The objective of this study was to examine the comparative effectiveness of a mailed DVD vs. DVD plus telephonic patient navigation (PN) vs. Usual Care (UC) for increasing the percentage of rural Midwestern women up to date (UTD) with 2018 United States Preventive Services Task Force CCS guidelines. Methods: As part of a larger study, 553 women (aged 50–74) who were not UTD for CCS were consented and randomized to one of the three study arms, DVD, DVD+PN, UC. Participants were assessed for baseline characteristics including sociodemographics, health status, and CCS beliefs by self-reported survey. Baseline and 12-month screening status were assessed by medical record review. Results: The mean age of participants was 59.8 years. When controlling for covariates in a logistic regression model, women had 4.52 (95% Confidence Interval [CI] = 2.09, 10.7, P &amp;lt; 0.001) greater odds of being UTD with CCS in the DVD + PN group vs. UC and 2.93 (95% CI = 1.63, 5.25, P &amp;lt; 0.001) greater odds of being UTD in the DVD + PN vs. DVD group. Other significant covariates included having higher odds (Odds Ratio [OR] = 4.76; 95% CI = 1.27, .33.33; P = 0.045) of becoming UTD if on private vs. public insurance; being normal (OR = 2.71; 95% CI = 1.14, 6.37; P = 0.022) or underweight (OR = 2.38; 95% CI = 1.12, 5.09; P = 0.024) vs. obese; and planning to have a Papanicolaou (Pap) test within the next six months (contemplation) (OR = 2.25; 95% CI = 1.23, 4.08; P = 0.008). Conclusions: A PN plus an interactive DVD intervention significantly improved the proportion of Midwestern rural women who became UTD with CCS compared to UC. Certain groups of women may be more at risk for not obtaining a CCS such as those who are on public insurance, obese, and not planning CCS. Future interventions should focus on women with these characteristics to increase CCS rates. A limitation of this study is that behavioral variables, such as contemplation, were measured in relation to Pap testing and did not include human papillomavirus (HPV) testing. As HPV testing/co-testing becomes more widely used, future interventions should examine behaviors specific to this screening.

A retrospective single-centre analysis of the prevalence of statin use in geriatric oncology: Is there a role for cessation?

e24016 Background: Statins have become ubiquitous in medicine. There is a myriad of indications, and the duration of treatment required for efficacy is measured in years. There is a need for clarity on their role in geriatric oncology and when to de-prescribe. Within a sample of Irish patients in 1987, 8% would have been eligible for a statin. By 2016, this had climbed to 61%. During this time, the number needed to treat increased from 40 to 400. In terms of benefit, a meta-analysis concluded that 100 patients need treatment for 2.5 years to prevent one major adverse cardiovascular event (MACE) in the primary preventative setting. It is not clear whether this benefit is derived in later life. As a result, the United States preventive service task force concluded that evidence is insufficient to recommend initiating a statin for primary prevention in adults over 75. The aim of our study was to assess the prevalence of statin use in older adults with cancer, and the evidence for de-prescribing. Methods: Data was retrospectively collected from a prospectively maintained database of patients attending the Geriatric Oncology Assessment and Liaision (GOAL) clinic in the South East Cancer Centre, University Hospital Waterford, Ireland. Data collected includes age at cancer diagnosis, stage, co-morbidities, and medications. We determined how many patients were taking statins (or ezetimibe) prior to first oncology review, their indication and overall survival. Indications for statins were categorised using a hierarchy of indications, as described by Wallach Kildemoes et al. Results: 138 of 233 patients were taking statins at the time of their review (59%). The average age at cancer diagnosis was 78.6 years. Seventy-nine were taking statins for primary prevention (58%). 15 of 79 whom had diabetes. Stage 3 or 4 disease accounted for 78% of this group. Overall survival in this group was 1.59 years. Within the group with stage 4 disease (n = 100), 53 were taking a statin. Twenty-eight (52.8%) were for primary prevention. Within this group, 6 had diabetes. Overall survival in this group was 1.44 years. Conclusions: Overall survival of patients was short of the 2.5 years required to provide benefit. Therefore, there is evidence to stop this medication in the primary preventative group, once diagnosed with advanced cancer. The stage 4 disease group included patients undergoing secondary prevention, so treatment is more efficacious. However, with an overall survival of 1.44 years, the window for benefit is small.[Table: see text]

Screening for colorectal cancer : Arecommendation statement of the Austrian National Committee for Cancer Screening.

Colorectal cancer is the fourth most common cancer in Austria. To date, colorectal cancer screening in Austria remains opportunistic and includes colonoscopy or stool-based blood tests. The Austrian National Committee for Cancer Screening developed evidence-based recommendations for anationwide organized colorectal cancer screening program. The methodological framework followed the approach of the United States Preventive Services Task Force. The evidence base underlying the newly developed recommendations comprised areview of the existing published evidence and adecision analytic model tailored to the Austrian context. Using astructured process, committee members considered 1)the magnitude of the net benefit of each screening strategy, 2)the certainty of evidence, and 3)the level of acceptance of the interventions among the target population. The Austrian National Committee for Cancer Screening recommends the implementation of anationwide organized colorectal cancer screening program for all adults aged 45-75years. For persons 65years or older, screening decisions should occur on an individual basis in accordance with aperson's overall health, prior screening history, and preferences. Specifically, the committee recommends either a10-year screening colonoscopy or biennial fecal immunochemical tests with colonoscopy following apositive result, with both screening strategies considered equivalent. Each citizen should be able to make an informed decision about their preferred screening method. Switching between the two screening strategies should be possible. Following an unremarkable colonoscopy, screening by fecal immunochemical test (FIT) is only required after 10years. Screening recommendations apply only to asymptomatic persons at average risk for colorectal cancer. The screening program must be pilot tested, and accompanied by apublic information campaign, formative evaluation, quality assurance, and data collection.

Patient and provider factors associated with colorectal cancer screening among average risk health plan enrollees in the US, 2015–2018

BackgroundTo assess patient and primary care provider (PCP) factors associated with adherence to American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) guidelines for average risk colorectal cancer (CRC) screening.MethodsRetrospective case-control study of medical and pharmacy claims from the Optum Research Database from 01/01/2014 − 12/31/2018. Enrollee sample was adults aged 50 − 75 years with ≥ 24 months continuous health plan enrollment. Provider sample was PCPs listed on the claims of average-risk patients in the enrollee sample. Enrollee-level screening opportunities were based on their exposure to the healthcare system during the baseline year. Screening adherence, calculated at the PCP level, was the percent of average-risk patients up to date with screening recommendations each year. Logistic regression modelling was used to examine the association between receipt of screening and enrollee and PCP characteristics. An ordinary least squares model was used to determine the association between screening adherence among the PCP’s panel of patients and patient characteristics.ResultsAmong patients with a PCP, adherence to ACS and USPSTF screening guidelines ranged from 69 to 80% depending on PCP specialty and type. The greatest enrollee-level predictors for CRC screening were having a primary/preventive care visit (OR = 4.47, p < 0.001) and a main PCP (OR = 2.69, p < 0.001).ConclusionsIncreased access to preventive/primary care visits could improve CRC screening rates; however, interventions not dependent on healthcare system contact, such as home-based screening, may circumvent the dependence on primary care visits to complete CRC screening.

Your New Year’s “resolution”—check your “screen!”

Your New Year’s “resolution”—check your “screen!”

Factors associated with breast cancer screening services use among women in the United States: An application of the Andersen's Behavioral Model of Health Services Use

This study applied Andersen's Behavioral Model of Health Services Use to examine predisposing, enabling, and need factors associated with adherence to the United States Preventive Services Task Force (USPSTF) guidelines for breast cancer screening (BCS). Multivariable logistic regression was used to determine factors of BCS services utilization among 5484 women aged 50–74 from the 2019 National Health Interview Survey. Predisposing factors significantly associated with use of BCS services were: being a Black (odds-ratios [OR]:1.49; 95% confidence interval [CI]:1.14–1.95) or a Hispanic woman (OR:2.25; CI:1.62–3.12); being married/partnered (OR:1.32, CI:1.12–1.55); having more than a bachelor's degree (OR: 1.62; CI:1.14–2.30); and living in rural areas (OR:0.72; CI:0.59–0.92). Enabling factors were: poverty level [≤138% federal poverty level (FPL) (OR:0.74; CI:0.56–0.97), >138–250% FPL (OR:0.77; CI:0.61–0.97), and > 250–400% FPL (OR:0.77; CI:0.63–0.94)]; being uninsured (OR:0.29; CI:0.21–0.40); having a usual source of care at a physician office (OR:7.27; CI:4.99–10.57) or other healthcare facilities (OR:4.12; CI:2.68–6.33); and previous breast examination by a healthcare professional (OR:2.10; CI:1.68–2.64). Need factors were: having fair/poor health (OR:0.76; CI:0.59–0.97) and being underweight (OR:0.46; CI:0.30–0.71). Disparities in BCS services utilization by Black and Hispanic women have been reduced. Disparities still exist for uninsured and financially restrained women living in rural areas. Addressing disparities in BCS uptake and improving adherence to USPSTF guidelines may require revamping policies that address disparities in enabling resources, such as health insurance, income, and health care access.

Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018

The United States Preventive Services Task Force (USPSTF) recommends that women with adequate prior screening and average cervical cancer risk discontinue routine cervical cancer screening after age 65. This study's objective was to estimate how the USPSTF recommendation affects Papanicolaou (Pap) test rates among women at age 66 in the United States. We used nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System data for women ages 56–76 (n = 226,031) and a regression discontinuity design to estimate changes in annual Pap test rates at age 66. Among women age 66–76, 22.5% reported receiving a Pap test within the past one year. At age 66, annual Pap rates declined by 5.9 percentage points (p.p.) (95% Confidence Interval [CI]: −7.7, −4.1) off a pre-66 rate of 39%. The change varied by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women (0.8 p.p.; 95% CI: −5.4, 7.1) but did for women from other racial/ethnic groups. The decline was larger for women who graduated college (−9.0 p.p.; 95% CI: −12.0, −5.9) than for women without a college degree and for women who were never married (−9.4 p.p., 95% CI: −17.3, −1.5) than for women who were married/partnered or divorced/separated. The USPSTF recommendation to discontinue cervical cancer screening after age 65 leads to a sharp decline in Pap test rates at age 66 but disparately affects women based on race, education and marital status. Further study is needed to assess the consequences of these changes.