United States Preventive Services Task Research Articles

Skin cancer biopsy and detection rates with total body skin examination: A cross-sectional retrospective analysis

To The Editor: Office-based skin cancer screening is limited in its capacity to screen entire populations. 1 Ferris L.K. Saul M.I. Lin Y. et al. A large skin cancer screening quality initiative: description and first-year outcomes. JAMA Oncol. 2017; 3: 1112-1115 Crossref PubMed Scopus (30) Google Scholar ,2 Welch H.G. Mazer M.L. Adamson A.S. The rapid rise in cutaneous melanoma diagnoses. N Engl J Med. 2021; 384: 72-79 Crossref Scopus (40) Google Scholar Most organizations worldwide recommend screening only at-risk individuals. 2 Welch H.G. Mazer M.L. Adamson A.S. The rapid rise in cutaneous melanoma diagnoses. N Engl J Med. 2021; 384: 72-79 Crossref Scopus (40) Google Scholar ,3 Ebell M.H. Thai T.N. Royalty K.J. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev. 2018; 39: 1-9 Crossref PubMed Scopus (51) Google Scholar In the United States, less than a quarter of those deemed to be at a high risk of skin cancer per the United States Preventative Services Task Force criteria undergo a total body skin examination (TBSE) in their lifetime. 4 Lakhani N.A. Saraiya M. Thompson T.D. King S.C. Guy Jr., G.P. Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010. Prev Med. 2014; 61: 75-80 Crossref PubMed Scopus (37) Google Scholar A lack of consensus for skin cancer screening guidelines has led to patient-driven screening. 5 Johnson M.M. Leachman S.A. Aspinwall L.G. et al. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Manag. 2017; 4: 13-37 Crossref PubMed Google Scholar This study evaluated factors that influence the likelihood of a skin biopsy during a TBSE and skin cancer detection upon biopsy.

Cost Savings of HPV Testing Alone Versus Co-Testing for Cervical Cancer Screening at a Student-Run Free Clinic

Background: Primary high-risk human papillomavirus (hrHPV) testing is an approved alternative method of cervical cancer screening by the United States Preventative Services Task Force. The University of South Florida BRIDGE (Building Relationships and Initiatives Dedicated to Gaining Equality) Clinic is a student-run free clinic with limited screening resources, serving patients below the poverty line. This study aimed to determine the potential cost benefit of primary hrHPV testing in this population.
 Methods: A retrospective observational study of clinic invoices and patient charts from January 2014 to December 2018 of women receiving cervical cancer screening by co-testing was performed. 
 Results: BRIDGE spent $29,122.37 on screening over the five-year period for 128 patients. By elimi-nating cervical cytology, the clinic would have saved $11,594.34. Fifteen patients had abnormal results, ten of which were hrHPV-positive.
 Conclusions: The $11,594 saved would allow BRIDGE to screen 110 more patients by primary hrHPV testing and another three by eliminating follow-up for atypical squamous cells of undetermined significance, hrHPV-negative results. One patient with low-grade squamous intraepithelial lesion and negative hrHPV represents a 0.8% risk of missing precancerous lesions the clinic would assume by adopting primary hrHPV testing.

Assessment and Efficacy of Low-Dose CT Screening and Primary Care Providers Perspective on Lung Cancer Screening: An Institutional Review.

Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers were included in the survey. The majority of the providers were aware of the USPSTF guidelines and believed that patients with multiple comorbidities and insurance issues were barriers in initiating LDCT screening. Lung cancer screening is an important component in cancer preventive strategies. Widespread awareness among the primary care providers and the public is extremely necessary for improving the use of LDCT.

Dose of aspirin to prevent preterm preeclampsia in women with moderate or high-risk factors: A systematic review and meta-analysis.

ObjectiveTo evaluate the effect of aspirin dose on the incidence of all gestational age preeclampsia and preterm preeclampsia.Data sourcesElectronic databases (Cochrane, PubMed, Scopus, ClinicalTrials.gov and the Web of Science) were searched for articles published between January 1985 and March 2019 with no language restrictions.MethodsWe followed the PRIMSA guidelines and utilized Covidence software. Articles were screened by 2 independent reviewers, with discrepancies settled by an independent 3rd party. Study selection criteria were randomized trials comparing aspirin for prevention of all gestational age and preterm preeclampsia to placebo or no antiplatelet treatment in women aged 15–55 years with moderate or high-risk factors according to the list of risk factors from American College of Obstetricians and Gynecologists and United States Preventive Services Task Force guidelines. The quality of trials was assessed using the Cochrane risk of bias tool. The data were pooled using a random-effects meta-analysis comparing aspirin at doses of <81, 81, 100, and 150 mg. Pre-specified outcomes were all gestational age and preterm preeclampsia.ResultsOf 1,609 articles screened, 23 randomized trials, which included 32,370 women, fulfilled the inclusion criteria. In preterm preeclampsia, women assigned at random to 150 mg experienced a significant 62% reduction in risk of preterm preeclampsia (RR = 0.38; 95% CI: 0.20–0.72; P = 0.011). Aspirin doses <150 mg produced no significant reductions. The number needed to treat with 150 mg of aspirin was 39 (95% CI: 23–100). There was a maximum 30% reduction in risk of all gestational age preeclampsia at all aspirin doses.ConclusionsIn this meta-analysis, based on indirect comparisons, aspirin at a dose greater than the current, recommended 81 mg was associated with the highest reduction in preterm preeclampsia. Our meta-analysis is limited due to the deficiency of homogeneous high evidence data available in the literature to date; however, it may be prudent for clinicians to consider that the optimal aspirin dose may be higher than the current guidelines advise. Future research to compare the efficacy aspirin doses greater than 81 mg is recommended.Study registrationPROSPERO, CRD42019127951 (University of York, UK; http://www.crd.york.ac.uk/PROSPERO/).

ES12.02 Defining High Risk

ES12.02 Defining High Risk

Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers

BackgroundBlack men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality.MethodsWe proposed a CHW-led decision-coaching program to facilitate SDM for prostate cancer screening discussions in Black men at a primary care FQHC. This study enrolled Black men who were patients at the participating clinical site and up to 15 providers who cared for them. We estimated to recruit 228 participants, ages 40–69 to be randomized to either (1) a decision aid along with decision coaching on PSA screening from a CHW or (2) receiving a decision aid along with CHW-led interaction on modifying dietary and lifestyle to serve as an attention control. The independent randomization process was implemented within each provider and we controlled for age by dividing patients into two strata: 40–54 years and 55–69 years. This sample size sufficiently powered the detection differences in the primary study outcomes: knowledge, indicative of decision quality, and differences in PSA screening rates.Primary outcome measures for patients will be decision quality and decision regarding whether to undergo PSA screening. Primary outcome measures for providers will be acceptability and feasibility of the intervention. We will examine how decision coaching about prostate cancer screening impact patient-provider communication. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured, in-depth interviews, and thematic analysis of clinical encounters. Through a conceptual model combining elements of the Preventative Health Care Model (PHM) and Informed Decision-Making Model, we hypothesize that the prostate cancer screening decision coaching intervention will result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction with counseling patients about prostate cancer screening.DiscussionDecision coaching is an evidence-based approach to improve decision quality in many clinical contexts, but its efficacy is incompletely explored for PSA screening among Black men in primary care. Our proposal to evaluate a CHW-led decision-coaching program for PSA screening has high potential for scalability and public health impact. Our results will determine the efficacy, cost-effectiveness, and sustainability of a CHW intervention in a community clinic setting in order to inform subsequent widespread dissemination, a critical research area highlighted by USPSTF.Trial registrationThe trial was registered prospectively with the National Institute of Health registry (www.clinicaltrials.gov), registration number NCT03726320, on October 31, 2018.

1142 Low dose aspirin influence on biomarkers of endothelial disruption and inflammation

To determine the low dose aspirin (LDA) on biomarkers related to inflammation, CRP, and endothelial activation, S-ICAM, which are potentially important in the pathogenesis of preeclampsia This was a prospective cohort study. Women aged 18-45 years with singleton gestation and who were defined as high risk for preeclampsia per United States Preventive Services Task Force guidelines were enrolled as cases. A convenience control sample of low risk women were enrolled as controls. Daily LDA was initiated between 11 and 16 weeks and continued until 36 weeks. Serum CRP and S-ICAM were assayed prior to aspirin initiation at 11-16 weeks and repeat assays were obtained at 28-32 weeks. Primary outcome included changes in CRP and S-ICAM levels over time reported as mean and standard error. T test and chi-square tests assessed comparisons of demographic data. Initial analyses were performed using mixed models for repeated measures to detect aspirin effects 132 women were enrolled: 67 on LDA, 65 were controls. Comparison of demographic variables identified significant differences in BMI, occupation, educational levels and insurance status between groups. No significant treatment effects were noted in CRP levels(ng/ml) between cases and controls at 11-16 weeks (14.16±1.37vs.11.17 ± 1.38 SE) and at 28-32 weeks (13.53±11.61vs.10.48±1.18SE). S-ICAM levels(ng/ml) were higher in cases than in controls at 11-16 weeks(77.8 ± 2.1SEvs70.4 ± 1.6SE) with a decline in cases and increase in controls at 28-32weeks(76.7 ± 3.2 SE vs 75.5 ± 2.2 SE). S-ICAM levels showed a significant treatment effect, P=.0097, in our repeated measures model. The direction of effect was to lower this value during the treatment interval We observed a treatment effect of LDA on reduced endothelial activation in this cohort study suggesting a mechanism of action for this intervention beyond known effects related to thromboxane metabolism

Challenges in lung cancer screening: a review of implemented programs

: Lung cancer screening (LCS) with annual low-dose computed tomography has been shown to have a mortality benefit in high-risk individuals. After publication of the National Lung Screening Trial in 2011, the United States Preventive Services Task Force recommended LCS in 2013, and Medicare began to cover it in 2015. The body of literature supporting LCS continues to grow; most recently the Dutch-Belgian LCS trial reaffirmed the substantial long-term reductions in mortality. Despite this, the rate of enrollment remains extremely low due to challenges at the patient, provider, and medical system levels. Several prominent organizations, including the American Association for Thoracic Surgery and the American Thoracic Society, have provided guidelines to develop a robust LCS program. The primary tenets include a structured referral network, multidisciplinary collaboration, comprehensive patient coordination and follow-up, standardized reporting and patient data management, and quality assurance. Numerous institutions in a variety of settings have used these guidelines and employed strategies of their own to improve the success of their respective LCS programs. This review outlines the challenges that currently exist, summarizes the principles of effective LCS, and details the experiences of several existing LCS programs in a variety of healthcare settings.

1057 Pregnancies treated with prophylactic low dose aspirin: a dose dependent comparison of obstetric outcomes

Low dose aspirin has been known as a potential treatment for prevention of the development of preeclampsia in high risk pregnancies since the 1980s. Since that time, multiple studies have confirmed this benefit as well as the reduction in rates of premature birth and low birth weight. As such, the United States Preventive Services Task Force (USPSTF) and American College of Obstetrics and Gynecology (ACOG) have published criteria outlining the pregnancies that most benefit from prophylactic low dose aspirin administration. However, there is no absolute recommendation as to the dosage of daily aspirin to be administered. We sought to determine if there is a dose dependent relationship for low dose aspirin prophylaxis and pregnancy outcomes. This was a retrospective cohort analysis of 231 pregnancies treated with prophylactic low dose aspirin in Kansas City between July 2016 and December 2019. Patients who did not receive prenatal care or deliver at our facility were excluded. We stratified patients by dose (81mg vs 162mg). Our outcomes of interest were gestational age at delivery and birthweight percentiles. Variables were compared using Student’s T-test. We found that the mean gestational age at delivery was later in the 81mg group than the 162mg group (37.84 +/- 2.16 weeks vs 36.55 +/- 4.74 weeks, p = 0.008) but birth weight percentiles were similar between groups (71.97% +/- 29.12 vs 58.41% +/- 29.66, p=0.606). The percentage of low birthweight infants were 8.2% (n=8) and 12.9% (n=20) in the 81mg and 162mg groups respectively, which are not statistically different from the general population. There was no difference in composite adverse neonatal events between groups. In this cohort of women treated with prophylactic low dose aspirin, increasing aspirin dose did not extend pregnancy duration or reduce the risk of low birthweight.

Low-dose aspirin in pregnancy: who? when? how much? and why?

The use of low dose aspirin (LDA) has become routine in prenatal care for a variety of diagnoses, most importantly in women with a history of preeclampsia and associated poor pregnancy outcomes. Although LDA is currently indicated in patients considered to be at risk for development of preeclampsia, optimal dosing, timing of treatment initiation, and persons of benefit are under investigation. Several studies have also looked at LDA treatment and its effect on other maternal and fetal outcomes. This review summarizes the current guidelines for the use of LDA, incorporating the most recent research findings, and offers possible future implications of LDA treatment. Over 10 years ago, the American College of Obstetricians and Gynecologists, the World Health Organization, and the United States Preventive Service Task Force began publishing guidelines focused on the use of LDA in pregnancy. Since the release of these guidelines, several large studies have re-evaluated the use of LDA with a focus on initiation of treatment and dosing. The combined results of these studies suggest a decreased rate of preeclampsia at aspirin doses >100 mg when treatment is initiated prior to 16 weeks of gestation. Overall, early initiation of LDA has been shown to decrease the development of preeclampsia in patients considered at increased risk. Current literature suggests increasing the recommended dose to >100 mg to optimize these risk reductions. Although LDA use seems promising for other outcomes like preterm delivery and intrauterine growth restriction, further studies to strengthen recommendations are warranted.

The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates.

To evaluate the relationship between direct cognitive assessment introduced with the Medicare Annual Wellness Visit (AWV) and new diagnoses of dementia, and to determine if effects vary by race. Medicare Limited Data Set 5% sample claims 2003-2014 and the HRSA Area Health Resources Files. Instrumental Variable approach estimating the relationship between AWV utilization and new diagnoses of dementia using county-level Welcome to Medicare Visit rates as an instrument. Three hundred twenty-four thousand three hundred and eighty-five fee-for-service Medicare beneficiaries without dementia when the AWV was introduced in 2011. Annual Wellness Visit utilization was associated with an increased probability of new dementia diagnosis with effects varying by racial group (categorized as white, black, Hispanic/Latino, or Asian based on Social Security Administration data). Hazard ratios (95% confidence intervals) for new dementia diagnosis within 6months of AWV utilization were as follows: 2.34 (2.13, 2.58) white, 2.22 (1.71, 2.89) black, 4.82 (2.94, 7.89) Asian, and 6.14 (3.70, 10.19) Hispanic (P<.001 for each). Our findings show that estimates that do not control for selection underestimate the effect of AWV on new diagnoses. Dementia diagnosis rates increased with AWV implementation with heterogenous effects by race and ethnicity. Current recommendations by the United States Preventive Services Task Force state that the evidence is insufficient to recommend for or against screening for cognitive impairment in older adults.

Scoliosis Screening.

The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam's forward bending test alone, Adam's forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.

Using Prediction Models to Reduce Persistent Racial and Ethnic Disparities in the Draft 2020 USPSTF Lung Cancer Screening Guidelines.

We examined whether draft 2020 United States Preventive Services Task Force (USPSTF) lung cancer screening recommendations "partially ameliorate racial disparities in screening eligibility" compared with the 2013 guidelines, as claimed. Using data from the 2015 National Health Interview Survey, USPSTF-2020 increased eligibility by similar proportions for minorities (97.1%) and Whites (78.3%). Contrary to the intent of USPSTF-2020, the relative disparity (differences in percentages of model-estimated gainable life-years from National Lung Screening Trial-like screening by eligible Whites vs minorities) actually increased from USPSTF-2013 to USPSTF-2020 (African Americans: 48.3%-33.4% = 15.0% to 64.5%-48.5% = 16.0%; Asian Americans: 48.3%-35.6% = 12.7% to 64.5%-45.2% = 19.3%; Hispanic Americans: 48.3%-24.8% = 23.5% to 64.5%-37.0% = 27.5%). However, augmenting USPSTF-2020 with high-benefit individuals selected by the Life-Years From Screening with Computed Tomography (LYFS-CT) model nearly eliminated disparities for African Americans (76.8%-75.5% = 1.2%) and improved screening efficiency for Asian and Hispanic Americans, although disparities were reduced only slightly (Hispanic Americans) or unchanged (Asian Americans). The draft USPSTF-2020 guidelines increased the number of eligible minorities vs USPSTF-2013 but may inadvertently increase racial and ethnic disparities. LYFS-CT could reduce disparities in screening eligibility by identifying ineligible people with high predicted benefit regardless of race and ethnicity.

Timely Mammography Use among a Sample of Black American Women: A Community-Based Study

Breast cancer deaths are more common among Black American women than White women. In 2012, the Centers for Disease Control and Prevention reported that Black American women had a higher incidence rate (130.0) compared to White women (128.9). But it is the double burden of incidence and low survival that is particularly alarming (American Cancer Society, 2011). While research is underway to better understand the role that genes play, such as those that are associated with the aggressive triple negative breast cancer which is more commonly diagnosed in Black American women, there is more to learn about the utilization of the screening mammography. At the time this study was conducted the age controversy to receive a baseline screening was just beginning. The American Medical Association, the American College of Radiology, and the American Cancer Society all supported baseline screenings at age 40 but, currently the United States Preventive Services Task Force guidelines recommend biennial screening for women aged 50 to 74 years who are at average risk for breast cancer. Furthermore, mammograms are not routinely recommended for women age 40 to 49 because they are more likely to have false biopsies. We do not yet know the long-term impact of implementing a longer timeline to screen for breast cancer. Although Black American women, have narrowed the gap, they still lag behind regarding mammography screening and are more likely to be diagnosed with an aggressive form of breast cancer. This paper investigates the predictors of mammography use among a small, low-income, U.S. community-based sample of Black African American women age 42 and older.

Prostate Cancer in Lebanon: Incidence, Temporal Trends, and Comparison to Countries From Different Regions in the World.

BackgroundProstate cancer is the most common malignancy in men globally. This study aims at investigating the incidence rates and trends of prostate cancer in Lebanon, and to compare them to those of countries from different regions in the world.MethodsData on prostate cancer were obtained from the Lebanese national cancer registry for the years 2005 to 2016. The calculated age-standardized incidence and age-specific rates were expressed as per 100 000 population.ResultsIn Lebanon, prostate cancer is ranked as the most common cancer in men. The age-standardized incidence rate of prostate cancer has increased from 29.1 per 100 000 in 2005 to 37.3 per 100 000 in 2016; the highest rate was in 2012, surpassing the global average incidence rate for that year. The age-specific incidence rate of prostate cancer has increased exponentially starting at the age of 50 years to reach its peak in men aged 75 years or more. Two trends were identified in the age-standardized incidence rate of prostate cancer; an average significant increase of 7.28% per year for the period 2005–2009 (P-value < .05), followed by a non-significant decrease of around .99% for the period between 2009 and 2016 (P-value > .05). The age-standardized incidence rate in Lebanon was higher than most countries in the Middle East and North Africa region and Asia, but lower than the rates reported in Australia, America, and different European countries.ConclusionProstate cancer is the leading cancer among men in Lebanon. Screening practices, changes in population age structure, and prevalence of genetic and risky lifestyle factors may explain the increased incidence rates of prostate cancer. Given the controversy of screening recommendations and the slow growing nature of prostate cancer, increasing public awareness on ways of prevention, and implementing the latest screening recommendation of the United States Preventive Services Task Force are the suggested way forward.

The health economic impact of varying levels of adherence to colorectal screening on providers and payers

Aims To examine the impact of increasing multi-target stool DNA test (mt-sDNA [Cologuard]) utilization for colorectal cancer (CRC) screening in cohorts aged 50–75 and 45–75 years old with varying levels of adherence from the perspectives of integrated delivery networks (IDNs) and payers. Materials and methods We developed a budget impact model that simulates CRC screening with colonoscopy over a 10-year time horizon, fecal immunochemical test (FIT), and mt-sDNA according to the United States Preventive Services Task Force and American Cancer Society guidelines for average risk adults. We evaluated varying levels of screening adherence for a status quo scenario and for an increased mt-sDNA utilization scenario, from the IDN and payer perspectives. The IDN perspective included CRC screening program costs, whereas the payer perspective did not. Conversely, stool-based screening test and bowel preparation costs were unique to the payer perspective. Results The increased mt-sDNA scenarios yielded cost savings relative to the status quo under all adherence scenarios due to a decrease in screening and surveillance colonoscopies. For ages 50–75, in high and low adherence scenarios, savings were $19.8 M ($0.16 per-person-per-month (PPPM)) and $33.3 M ($0.28 PPPM) from the IDN perspective. From the payer perspective, savings were $4.2 M ($0.03 PPPM) and $6.7 M ($0.06 PPPM). For ages 45–75, in high and low adherence scenarios, cost savings were $19.3 M ($0.16 PPPM) and $33.0 M ($0.28 PPPM) from the IDN perspective and $3.9 M ($0.03 PPPM) and $6.2 M ($0.05 PPPM) from the payer perspective. In all imperfect adherence scenarios, the degree of cost-savings with increased mt-sDNA utilization correlated with the aggregate decrease in screening and surveillance colonoscopies. Limitations Estimates of real-world adherence levels were based on cross-sectional screening data from the literature, and assumptions were applied to individual screening modalities and screening scenarios. Conclusions Among all adherence scenarios, perspectives, and age ranges, increased mt-sDNA utilization yielded cost-savings.

Incidental finding of renal cell carcinoma in an asymptomatic patient on low-dose computed tomography screening for lung cancer

INTRODUCTION In 2013, the United States Preventive Services Task Force recommended annual low-dose computed tomography (CT) screening for lung cancer in high-risk adults with a significant smoking history. These screenings result in large numbers of incidental findings, and although most of these do not warrant further investigation, there have been reported cases of incidental findings identified on CT screening that led to successful treatment of a previously undiagnosed comorbidity. CASE HISTORY Here, we report a case of papillary renal cell carcinoma that was detected incidentally on low-dose CT in an asymptomatic individual, a rare diagnosis considering that renal neoplasms account for <1% of incidental findings on these screenings. CONCLUSION This case highlights the value of investigating these incidental findings, with the goal of detecting underlying disease in some cases before it would have presented symptomatically.

A narrative review of lung cancer screening in underserved populations

: Lung cancer screening with low-dose computed tomography (LDCT) is an effective approach for the early detection of lung cancer and the reduction of lung cancer specific mortality in high risk individuals. Despite recommendations for LDCT screening by the National Comprehensive Cancer Network (NCCN) and the United States Preventive Services Task Force, the utilization of LDCT screening in clinical practice has been low. Moreover, significant disparities in the use of LDCT have been described in underserved populations, including African American or black patients, rural patients with limited access to LDCT screening facilities, and other vulnerable patient groups with known risk factors for developing lung cancer. Several patient, provider, and healthcare systems level approaches have been proposed to mitigate lung cancer screening disparities. Such approaches include raising awareness of LDCT screening benefits and the evidence in support of LDCT screening among healthcare providers, educating patients on LDCT screening and optimizing shared decision-making approaches between patients and providers, and expanding patient access to LDCT screening through free and mobile lung cancer screening programs. As lung cancer screening utilization continues to expand in clinical practice, it will be critical to continue investigating the trends, causes, and outcomes of LDCT screening disparities in underserved populations.

1059. Evaluating Hepatitis C Screening Rates and Successful Interventions at an Outpatient Medicine/Pediatrics Practice

BackgroundDespite the 2013 United States Preventive Services Task Force (USPSTF) recommendations, Hepatitis C (HCV) screening rates among patients born between 1945-1965 has remained below 25% (MacLean, 2018). At our outpatient academic suburban primary care practice in Albany County, NY, our hepatitis C baseline prior to interventions was 31.75%. In collaboration with Project FOCUS through Gilead, our practice attempted to increase screening rates among this birth cohort.MethodsWe performed a retrospective chart review on patients eligible for HCV screening with birth years 1945-1965 at the time of their visit at the Albany Med Internal Medicine/Pediatrics practice. We report monthly HCV screening from January 2018 to April 2020. In addition, we determined whether HCV screening rates differed by race, gender, ethnicity, private vs public insurance, and risk stratification or RAF (standard vs. high-risk patient).ResultsThe chance that a test conducted for eligible patients increased from 29.9% (pre-intervention) to 58.76% in 2019 (post-intervention). From June 2019- December 2019, the testing rates were consistently above the 2019 average (Figure 1). There were no significant differences in HCV screening due to gender, race, ethnicity, or type of insurance (Table 1).Figure 1. Hepatitis C Screening Rates at an Outpatient Medicine/Pediatrics Practice 2018-2020 Table 1. Demographics - Hepatitis C Screening Rates ConclusionIn this outpatient Med/Peds practice, hepatitis C screening rates increased dramatically after incorporation of an EMR prompt, as well as nursing-generated orders for patients due for screening. There was no statistical difference in screening based on race, ethnicity, gender, or insurance type. Of note, high-risk patients were more likely to be screened, perhaps as they receive more case management services and are more likely to be in the office, increasing the opportunities for screening. The next step would be to adapt these interventions to screening all patients age 18-79, as per the updated 2020 USPSTF guidelines.Disclosures Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Abigale Eichelman, MA, Gilead FOCUS Foundation (Other Financial or Material Support, Employee of Albany Medical Center with Salary Support on Grant) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)

1058. Demographics of Hepatitis C Virus Antibody and RNA Positivity within an Emergency Department Screening Program

BackgroundIn support of the recent United States Preventive Services Task Force’s (USPSTF) revised recommendations for non-targeted HCV screening, we have noted a shift away from active infections within the birth cohort (patients born between 1945-1965), as these individuals have often undergone successful treatment, and a shift towards younger adults who are RNA positive, especially people who use intravenous drugs (PWID).MethodsLocated in Northeastern New York State, Albany Medical Center conducts routine emergency department (ED) HCV screening, with active linkage to care. We performed a retrospective study of our HCV linkage to care data from April 2019 to June 2020. Patients were offered screening if they belonged to the birth cohort, were PWID, or at staff discretion. We estimated the effect of birth cohort, intravenous drug use and other potential risk factors on RNA positivity via Chi-square tests and Modified Poisson Regression.ResultsThere were 242 people that were HCV antibody positive. The mean age was 50.9 years-old, with 118 (46.8%) in the birth cohort and 103 (42.56%) PWID. As compared to the birth cohort, a significantly greater proportion of non-birth cohort patients were PWID (62% vs 21.2%, p< 0.01) and homeless (17.7% vs 9.3%, p=0.05). Birth cohort patients were 0.55 times (95%CI: 0.39 to 0.79) less likely to be RNA positive. PWID were 2.22 times (95% CI: 1.58 to 3.13) and homeless people were 2.05 times (95% CI: 1.50 to 2.80) more likely to be RNA positive. After multivariable adjustment, birth cohort was not a significant risk factor for RNA positivity but PWID (RR: 1.84; 95% CI: 1.26 to 2.68) and homelessness (RR: 1.69; 95% CI: 1.20 to 2.39) were significantly associated with RNA positivity.ConclusionThese data suggest that the RNA positivity rate is higher among the non-birth cohort age group but is explained by the higher prevalence of drug use and homeless. The findings support USPSTF’s new guidelines for testing all adults and shed light on the demographics of populations at risk for active infection vs. populations who are antibody positive and RNA negative. Further research might explore (a) whether these findings are applicable to other clinical settings and geographic locations and (b) the feasibility of targeting patients with active infection in settings such as the ED.DisclosuresTalia A. Segal, BS, GILEAD FOCUS Foundation (Grant/Research Support) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Adam Rowden, DO, GILEAD FOCUS Foundation (Grant/Research Support) Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)