United States Preventive Services Task Force Guidelines Research Articles

National Trends in the Incidence of Sporadic Malignant Colorectal Polyps in Young Patients (20-49 Years): An 18-Year SEER Database Analysis.

Background and Objectives: Conflicting guidelines exist for initiating average-risk colorectal cancer screening at the age of 45 years. The United States Preventive Services Task Force (USPSTF) changed its guidelines in 2021 to recommend initiating screening at 45 years due to an increasing incidence of young-onset colorectal cancer. However, the American College of Physicians (ACP) recently recommended not screening average-risk individuals between 45 and 49 years old. We aim to study the national trends in the incidence of sporadic malignant polyps (SMP) in patients from 20 to 49 years old. Materials and Methods: We analyzed the Surveillance, Epidemiology, and End Results database (2000-2017) on patients aged 20-49 years who underwent diagnostic colonoscopy with at least a single malignant sporadic colorectal polyp. Results: Of the 10,742 patients diagnosed with SMP, 42.9% were female. The mean age of incidence was 43.07 years (42.91-43.23, 95% CI). Approximately 50% of malignant polyps were diagnosed between 45 and 49 years of age, followed by 25-30% between 40 and 45. There was an upward trend in malignant polyps, with a decreased incidence of malignant villous adenomas and a rise in malignant adenomas and tubulovillous adenomas. Conclusions: Our findings suggest that almost half of the SMPs under 50 years occurred in individuals under age 45, younger than the current screening threshold recommended by the ACP. There has been an upward trend in malignant polyps in the last two decades. This reflects changes in tumor biology, and necessitates further research and support in the USPSTF guidelines to start screening at the age of 45 years.

A qualitative study of primary care clinician’s approach to ending cervical cancer screening in older women in the United States

The United States Preventive Services Task Force (USPSTF) recommends that cervical cancer screening end in average-risk patients with a cervix at 65 years of age if adequate screening measures have been met, defined as having 1) at least three normal consecutive cytology (Pap) tests, or 2) two normal cytology tests and/or two negative high-risk human papillomavirus tests between ages 55–65; the last test should be performed within the prior 5 years. Up to 60 % of all women aged 65 years and older who are ending screening do not meet the criteria for adequate screening. The objective of this study was to understand the process and approach that healthcare clinicians use to determine eligibility to end cervical cancer screening. In 2021 we conducted semi-structured interviews in San Francisco, CA with twelve healthcare clinicians: two family medicine physicians, three general internal medicine physicians, two obstetrician/gynecologists and five nurse practitioners. Thematic analysis, using inductive and deductive coding, was utilized. Three major themes emerged: following guidelines, relying on self-reported data regarding prior screening, and considering sexual activity as a factor in the decision to end screening. All interviewees endorsed following the USPSTF guidelines and they utilized self-report to determine eligibility to end screening. Clinicians’ approach was dependent in part on their judgement about the reliability of the patient to convey their screening history. Sexual activity of the patient was considered when making clinical recommendations. Shared decision-making was often utilized. Clinicians voiced a strong reliance on self-reported screening history to end cervical cancer screening.

Leveraging quality improvement to promote health equity: standardization of prenatal aspirin recommendations

ObjectiveAspirin (ASA) is recommended for patients at elevated risk of preeclampsia. Limited data exists on adherence to guidelines for ASA prescription. This project evaluates the implementation of a standardized approach to ASA prescription in an academic OB/Gyn practice.MethodsWe implemented a quality improvement project to evaluate compliance with the United States Preventative Services Task Force (USPSTF) recommendations for ASA to prevent preeclampsia. Pre-intervention, we analyzed prescription adherence at 201 New Obstetric (NOB) visits. A multi-step intervention was then implemented at 199 NOB visits. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having ≥1 high-risk factor or ≥2 moderate-risk factors. ASA orders were placed by physicians. A Plan-Do-Study-Act (PDSA) cycle was performed, and changes implemented. Primary outcome was percent of patients screened at RN intake visit (goal = 90%). Secondary outcomes were percent of patients who screened positive that received the ASA recommendation (goal = 80%) and percent screened and recommended by race.ResultsPre-intervention, 47% of patients met criteria for ASA and 28% received a documented recommendation. Post-intervention, 99% were screened. Half (48%) met criteria for an ASA recommendation and 79% received a recommendation (p = < 0.001). Rates of appropriate recommendation did not differ by Black (80%) vs. non-Black (79%) status (p = 0.25). Subsequent PDSA cycles for 12 months neared 100% RN screening rates. Physicians correctly recommended ASA 80–100% of the time.ConclusionIt is feasible, sustainable and equitable to standardize screening and implementation of ASA to patients at high risk for preeclampsia. Providers can easily reproduce our processes to improve delivery of equitable and reliable preventative obstetric care.

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..

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.

MP77-08 PROSTATE CANCER PRESENTATION IN A COMMUNITY SETTING A DECADE SINCE THE USPSTF GRADE D RECOMMENDATION

You have accessJournal of UrologyCME1 Apr 2023MP77-08 PROSTATE CANCER PRESENTATION IN A COMMUNITY SETTING A DECADE SINCE THE USPSTF GRADE D RECOMMENDATION Franklin Gaylis, Edward Cohen, Paul Dato, Rose Prime, Julie Cramer, Katayune Golshan, Sonia Romo, Sepi Mahooti, Michael Leapman, Robert Topp, and William Catalona Franklin GaylisFranklin Gaylis More articles by this author , Edward CohenEdward Cohen More articles by this author , Paul DatoPaul Dato More articles by this author , Rose PrimeRose Prime More articles by this author , Julie CramerJulie Cramer More articles by this author , Katayune GolshanKatayune Golshan More articles by this author , Sonia RomoSonia Romo More articles by this author , Sepi MahootiSepi Mahooti More articles by this author , Michael LeapmanMichael Leapman More articles by this author , Robert ToppRobert Topp More articles by this author , and William CatalonaWilliam Catalona More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The United States Preventative Services Task Force (USPSTF) issued a grade “D” recommendation against PSA-based prostate cancer (PCa) screening in 2012. We present an analysis of a prospectively collected data repository including PCa tumor burden, Gleason score group, PSA and prostate biopsy positivity rates in a community setting a decade since the Task Force recommendation METHODS: We identified 7,914 patients undergoing prostate biopsy between April 2011 and December 2021 from the Genesis Healthcare Partner’s (large urology group practice) electronic medical record (EMR). For 2011, we annualized the number of biopsies performed based on an imputed estimate from April through December of 2011. We compiled the number of prostate biopsies and proportions of biopsies demonstrating cancer, Gleason score (6, 7, 8-10), and the maximum positive biopsy core percentage involvement with cancer. Statistical analysis included Chi Square and a one-way ANOVA. RESULTS: The annual biopsy rate was significantly higher in 2011 (997 cases [748 actual cases plus 249 estimated cases] than for all other years. Chi Square analysis indicated a significant consistent increase (p<0.001) in the percentage of positive biopsies between 2011 (44.25%) and 2021 (65.91%). The proportion of low grade disease significantly decreased (p<0.001) between 2011 and 2021 from 49.12% to 33.33%, while the proportion high grade disease significantly increased (p<0.001) from 16.47% to 27.59%. The proportion of intermediate grade disease significantly increased (p<0.001) from 34.41% in 2011 to 39.08% in 2021. The mean maximum positive biopsy core percentage was lower in 2011 (48.00+.33%) versus 2021 (55.00+.29%) (p<0.001). A non-parametric independent samples Kruskal-Wallis test with Bonferroni post hoc comparisons indicated that the median PSA levels were similar during 2011-2012 (6.7 – 6.9 ng/ml) and were significantly lower (p<.05) than the median PSA values measured during 2020-2021 (8.5 – 9 ng/ml). Study limitations include uncertainty about the extent of adoption of USPSTF guidelines in the practices, possible inaccurate attribution of causality (versus imaging and biomarker effects). Its strengths include prospective acquisition of granular data and findings that align with studies showing increases in metastatic disease and PCa-specific mortality during this interval. CONCLUSIONS: We identified a temporal association between the USPSTF 2012 recommendation against screening and increasing volume and proportion of high-grade prostate cancer. This trend was not reversed following the 2018 ‘Grade C’ revision to the USPSTF guideline. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1104 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Franklin Gaylis More articles by this author Edward Cohen More articles by this author Paul Dato More articles by this author Rose Prime More articles by this author Julie Cramer More articles by this author Katayune Golshan More articles by this author Sonia Romo More articles by this author Sepi Mahooti More articles by this author Michael Leapman More articles by this author Robert Topp More articles by this author William Catalona More articles by this author Expand All Advertisement PDF downloadLoading ...

Improving lung cancer screening rates among patients with head and neck cancer in a radiation oncology clinic.

The United States Preventive Services Task Force (USPSTF) recommends lung cancer screening via annual low dose computed tomography (LDCT) for high risk patients. Despite the strong evidence of a mortality benefit from several randomized clinical trials, rates of lung cancer screening remain low. We plan to assess how screening guidelines are implemented in a radiation oncology clinic for patients with head and neck cancer. A single institution, retrospective chart review was used to identify patients with head and neck cancer seen in a radiation oncology clinic who were potentially eligible for lung cancer screening under the current USPSTF guidelines. Patients who were potentially screening-eligible were enrolled in a phone survey to assess their knowledge about lung cancer screening and willingness to be screened. Of the 184 patients with head and neck cancer seen in the clinic, 8 (4%) patients were eligible for lung cancer screening under the previous USPSTF recommendations, including 1 (0.5%) patient already being screened. One patient (0.5%) became eligible under the expanded guidelines. All 184 patients had smoking history documented. Of the 87 current or former smokers, there were 24 (28%) who did not have pack-years documented; of the 82 former smokers, there were 8 (10%) who did not have quit date documented. Among the 16 phone survey participants (response rate: 70%) only 6 (38%) were aware there is a way to screen for lung cancer and 12 (75%) patients would be interested in screening if they are found to be eligible. These findings highlight a potential opportunity to increase rates of lung cancer screening among patients with head and neck cancer by both enhancing provider awareness as well as patient education at the community level.

Leveraging Quality Improvement to Promote Health Equity: Prenatal Aspirin Recommendations by Race [A303

INTRODUCTION: Black patients are disproportionately affected by preeclampsia and associated morbidity and mortality. Aspirin (ASA) reduces these risks and the United States Preventative Services Task Force (USPSTF) recommends ASA for pregnant patients at moderate to high risk for preeclampsia. We aimed to assess whether a quality-improvement intervention to standardize ASA screening and prescription resulted in similar rates of indicated ASA recommendations for patients who self-identified as Black versus non-Black. METHODS: Using a quality-improvement framework, we implemented universal prenatal screening according to the USPSTF recommendations for ASA to prevent preeclampsia. We analyzed 201 new OB (NOB) visits pre-intervention and 199 NOB visits 3 months post-intervention. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having 1 or more high-risk factor or 2 or more moderate-risk factors. ASA orders were signed by physicians. Results were stratified by self-identified Black versus non-Black race. RESULTS: Pre-intervention, 88% of Black patients met criteria, and 29% of those patients correctly received a recommendation for ASA. Among non-Black patients, 41% met criteria for ASA, and 27% of those patients a recommendation. Post-intervention, 93% and 41% of Black and non-Black patients met criteria, respectively, with 80% and 79% of those patients, respectively, receiving the recommendation. CONCLUSION: A strikingly high percentage of Black patients warrant a recommendation for ASA to reduce preeclampsia risk, as per USPSTF guidelines. Our standardized approach to prenatal screening and prescribing of ASA resulted in similar rates of correct prescriptions for ASA in Black and non-Black patients, suggesting a mechanism for delivering equitable preventative obstetric care.

Abstract PO-258: Disparities in eligibility for low-dose CT (LDCT) lung cancer screening among a multiethnic population

Abstract Introduction: African Americans and Native Hawaiians have a higher risk of lung cancer and greater mortality rate than other racial/ethnic groups in the US. The guidelines for lung cancer screening by low-dose CT scan were derived from clinical trial data conducted primarily in white men. In 2021, to address the underlying ethnic/racial disparities in eligibility for lung cancer screening the United States Preventive Services Task Force (USPSTF) updated the 2013 guidelines from 55-80 years of age, current or former smokers (quit ≤15 years) with a 30 pack-year smoking history to include ever smokers ≥50 years of age and with a ≥20 pack-year history. We hypothesize that the disparities in eligibility across race/ethnicity will remain due to the greater age-specific risk and lower pack-years among African Americans and Native Hawaiians. Methods: We used the Multiethnic Cohort study (MEC) data to examine ineligibility to both USPSTF guidelines by sex and race/ethnicity among 1,761 incident lung cancer cases diagnosed within 7 years of study entry. This analysis included African and Japanese Americans, Latino, Native Hawaiians and whites. Smoking history was collected by a self-administered questionnaire at cohort entry. The difference in proportion of ineligible for each group compared to whites were assessed. Results: Among the 1,042 men and 719 women with incident lung cancer, under the 2013 guidelines, 54% of men and 70% of women would have been ineligible for lung cancer screening. Under the 2021 guidelines, 41% of men and 59% of women would have been eligible. For the 2013 guidelines, in men, the disparity was highest in Latinos (19% difference compared to whites), followed by Native Hawaiians (18%), and African (17%) and Japanese (9%) Americans. In women, the disparity was highest in African Americans (33%), followed by Latinas (25%), Japanese Americans (25%), and Native Hawaiians (13%). While an additional ~12% of overall lung cancer cases would have been eligible for screening using the updated guidelines, the disparity in eligibility compared to whites for each racial/ethnic group remained similar (range: 9% in Japanese American men to 33% in African American women). Eleven percent of men and 28% of women would have been ineligible for never smoking. Among ineligible ever smokers, more non-whites than whites were ineligible due to the 20 pack-year threshold (men: 77% vs 64% and women: 90% vs 76%). Also, while an overall 8% of both men and women would have been ineligible due to the age threshold, &amp;gt;20% of Native Hawaiian cases were ineligible due to age. Conclusions: Our findings demonstrate that despite the lower thresholds in the smoking history and age criteria in the updated USPSTF guidelines, racial/ethnic disparities in lung cancer screening eligibility remains. Reasons for these differences include a lower smoking pack-year history and greater age-specific risk among ever smokers, and a higher proportion of never smoker lung cancer cases. Additional analyses with cumulative smoking history are in progress. Citation Format: S. Lani Park, Kyla Yamashita, Lenora Loo, Daniel Stram, Yurii Shvetsov, Loic Le Marchand. Disparities in eligibility for low-dose CT (LDCT) lung cancer screening among a multiethnic population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-258.

BRIDGING THE GAP TO IMPROVE THE RATE OF LUNG CANCER SCREENING IN A MINORITY POPULATION: A QUALITY IMPROVEMENT INITIATIVE IN A COMMUNITY HOSPITAL

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: The rate of lung cancer cases in New York City has decreased from 51.5 per 100,000 population in 1976 to 46.9 per 100,000 population in 2017. Over that same time period, the number of cases has steadily increased from 3929 cases per year in 1976 to 4507 cases per year in 2017. Mortality rate has decreased during this same time period from 42.0 per 100,000 to 24.0 per 100,000. This is likely due to an increased rate of screening protocols for lung cancer and subsequent earlier interventions. The National Lung Cancer Screening Trial (NLCST) showed a 15-20% lower risk of dying from lung cancer with participants who received low dose computed tomography (LDCT) scan versus participants who received standard chest radiograph. Data from our institution has shown that the rate of lung cancer screening studies are estimated at 10%. Studies have shown that the inadequate assessment of smoking history was a fundamental barrier to identify screen appropriate populations. The purpose of this study is to increase the rate of lung cancer screening in our patient population with a quality improvement project to identify smoking history. METHODS: A team of internal medicine residents conducted a retrospective chart review of 452 patients seen in our outpatient clinic over a period of 6 months. We updated the smoking history documentation for all of the patients and then we identified the age appropriate screening population based on the United States Preventive Services Task Force (USPSTF) guidelines for LDCT. The primary care physicians for this population were then notified to schedule a referral to the cancer screening coordinator in order to arrange LDCT screening. Our process measure was new referrals for LDCT. RESULTS: First we identified patients who were eligible for LDCT based on prior documentation; this was 21 patients (4.6%). After updating the smoking history, 89 patients (19.7%) were eligible for LDCT as per USPSTF guidelines. Of these patients, 16 (18%) had pending referrals to our screening coordinator, leaving a population of 73 (82%) patients who were not referred for screening. Due to our intervention, 23 (31.5%) patient were referred for LDCT. This represents a 6% increase in the number of referrals for age appropriate lung cancer screening. CONCLUSIONS: Our study has shown that with proper documentation of smoking history, you can increase the rate of referrals for age appropriate lung cancer screening which would in turn lead to earlier detection and treatment. Providing education and EMR alerts to raise awareness regarding screening eligibility would substantially increased the screening rate in our clinics. CLINICAL IMPLICATIONS: Research has shown that screening for lung cancer with LDCT has shown to decrease mortality and with proper documentation, the number of persons referred for LDCT could be increased which may in turn lead to early detection and treatment for lung cancer. DISCLOSURES: No relevant relationships by Sai Achi, source=Web Response No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Janet Joseph, source=Web Response No relevant relationships by Richard Sheppard, source=Web Response

P61.04 Disparities Related to Low-Dose Computed Tomography Screening Eligibility Criteria for Lung Cancer: A Single-Center Analysis

The United States Preventive Services Task Force (USPSTF) published guidelines in 2013 for lung cancer screening using low-dose computed tomography (LDCT) based on the National Lung Screening Trial results. Both the 2013 and expanded 2021 guidelines may perpetuate disparities as they do not take into account multiple risk factors. Risk-based models, such as the PLCOm2012, include criteria that impact diverse populations, particularly women and Black individuals, at high risk for lung cancer. The goal of this analysis was to compare the percentage of lung cancer cases who would have been eligible for LDCT screening according to the 2013 USPSTF guidelines versus the risk-based assessment.

PD50-11 CHANGES IN PSA SCREENING RELATIVE TO THE REVISED USPSTF GUIDANCE FOR PROSTATE CANCER SCREENING

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-11 CHANGES IN PSA SCREENING RELATIVE TO THE REVISED USPSTF GUIDANCE FOR PROSTATE CANCER SCREENING Michael Leapman, Rong Wang, Cary Gross, and Xiaomei Ma Michael LeapmanMichael Leapman More articles by this author , Rong WangRong Wang More articles by this author , Cary GrossCary Gross More articles by this author , and Xiaomei MaXiaomei Ma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In April 2017 the United States Preventive Services Task Force (USPSTF) published a draft guideline that reversed 2012 guidance against routine screening for prostate cancer, instead endorsing individual decision-making (a ‘Grade C’ recommendation) for men aged 55-69 but continued to discourage screening for patients >70 years. We estimated the effects of the guideline change on prostate specific antigen (PSA) testing practices in a large privately insured population in the U.S. METHODS: We accessed claims from Blue Cross Blue Shield, the largest private commercial insurance carrier, to evaluate trends in PSA testing among patients aged 40-89 years from January 1, 2013 through December 31, 2019 with continuous insurance for at least 12 months. We calculated crude and age-adjusted rates of PSA screening based on laboratory and procedure codes. We used interrupted time series analyses to evaluate the effects of the draft (April 2017) and published (May 2018) USPSTF guideline on rates of PSA testing. We further examined effects within the subset of age across commonly used cutoffs for screening identified in the guideline (40-54, 55-69, and 70-89 years). RESULTS: We identified a cohort of 17,553,527 eligible insurance beneficiaries. In the period preceding the 2017 statement, the PSA testing rate was 33.3 per 100 person-years (standard deviation, SD 1.24). Rates of testing increased following the publication of the draft guideline to 35.2 per 100 person-years (SD 1.60). Interrupted time series analysis revealed a significant increasing time trend in the post-draft period, across all age groups (p<0.01). The largest overall increases occurred among beneficiaries aged 50-69 years (from 50.0 to 54.1 per 100 person-years, p<0.001) in the periods before and after the guideline change, respectively. CONCLUSIONS: Rates of PSA testing increased following changes to the USPSTF’s draft statement in 2017, reversing trends seen following earlier guidance against PSA testing for all patients. Increases in testing among older patients may renew concerns about the clinical application of PSA testing to individuals less likely to benefit. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e856-e856 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Leapman More articles by this author Rong Wang More articles by this author Cary Gross More articles by this author Xiaomei Ma More articles by this author Expand All Advertisement Loading ...

An assessment of the United States Preventive Services Task Force cervical cancer screening guidelines

<h3>Objectives:</h3> United States Preventive Services Task Force (USPSTF) screening guidelines are widely used to establish standards of care. There are gaps, however, in the study populations on which the 2018 USPSTF cervical cancer screening guidelines are based. The purpose of this study is to: 1) conduct a systematic review of the studies that comprise these guidelines, focusing on high risk United States (US) populations as defined by self-identified race or ethnicity, age ≥65, and insurance status, 2) analyze the generalizability of the guidelines to high risk US populations. <h3>Methods:</h3> We accessed the USPSTF 2018 Cervical Cancer screening guidelines and the evidence summary and reviewed the seven randomized control trials (RCTs), four cohort studies, and one cross-sectional analysis that provided the evidence for these recommendations. We identified demographic data specific to self-identified race or ethnicity, age ≥65, and insurance status. Additionally, we reviewed the latest cervical cancer screening guidelines published by the National Comprehensive Cancer Network (NCCN), American Society for Colposcopy & Cervical Pathology (ASCCP), American College of Obstetrics & Gynecology (ACOG), American Society for Clinical Pathology (ASCP), and the American Cancer Society (ACS). Finally, in August 2020, we searched PubMed for RCTs, meta-analyses, clinical trials, systematic reviews from 2015-2020, focusing on our pre-identified demographic data. <h3>Results:</h3> Two of the 14 studies used as the basis for the 2018 USPSTF cervical cancer screening include race or ethnicity data (Table 1). Of these two studies, one was a US-based cohort study and the other a cross-sectional study from the United Kingdom (Table 1). None of the RCTs used for the USPSTF guidelines included race or ethnicity. All seven RCTs were conducted in countries with less racial diversity than the US, except for Canada (Table 1). Four studies included participants age ≥65. Eleven of the 14 studies were conducted in countries with some form of universal health care coverage. Of the non-USP-STF organizations, the 2019 ASCCP guidelines used three cohorts that included majority White participants, low-income patients, and individuals age ≥65. Of the 629 PubMed articles reviewed, 18 studies suggested that the application of current cervical cancer screening guidelines to high risk populations may lead to underscreening and delay in diagnosis. <h3>Conclusions:</h3> While the screening guidelines from USPSTF and non-USPSTF organizations discuss the existence of broad disparities in cervical cancer screening, few of the studies used to comprise these guidelines specifically include high risk populations in the US as defined by self-identified race or ethnicity, age ≥65, insurance status. In addition, the generalizability of these guidelines to a US population remains limited given the participant demographics enrolled in the studies that comprise these guidelines.

Risk Factors for Lung Cancer in an Underrepresented Safety-Net Screening Cohort

Introduction/BackgroundThe USPSTF (United States Preventive Services Task Force) guidelines suggest criteria centering on smoking status and age to select patients for lung cancer screening. Despite the significant advances in screening with low-dose computed tomography (LDCT), cancer detection rate is low (1.1%), highlighting the need to investigate possible ways to refine the current lung cancer screening strategy. Our aim was to determine clinical risk factors predictive of lung cancer in an urban safety-net hospital. Materials and MethodsWe performed a retrospective chart review of 2847 patients who received LDCT screening for lung cancer between 3/1/2015 and 12/31/2019. Patient demographics and medical history were collected. A bivariate logistic regression was used to evaluate predictors of lung cancer. ResultsCompared to the National Lung Cancer Screening Trial (NLST) population, our screening cohort had significantly more African Americans (38.2% vs. 4.5%, P < .0001), more obesity (32.7% vs. 28.3%, P < .0001), and higher rates of chronic obstructive pulmonary disease (COPD) (45.9% vs. 5.0%, P < .0001). The strongest predictors of lung cancer were COPD (odds ratio [OR] = 2.14, P < .0001) and a family history of lung cancer (OR = 2.77, P < .0001). Age (OR = 1.04, P< .001) and pack years (OR = 1.01, P< .001) were less predictive. ConclusionA diagnosis of COPD and family history of lung cancer were most predictive of lung cancer in a screening cohort at our urban safety-net hospital. Future studies should focus on whether inclusion of these additional risk-factors improves proportion of lung cancer detected via screening.

Addressing Sex Disparities in Lung Cancer Screening Eligibility: USPSTF vs PLCOm2012 Criteria

Lung cancer is the leading cause of cancer death in women in the United States. Prospective randomized lung screening trials suggest a greater lung cancer mortality benefit from screening women compared with men. Do the United States Preventative Services Task Force (USPSTF) lung screening guidelines that are based solely on age and smoking history contribute to sex disparities in eligibility, and if so, does the use of the PLCOm2012 risk prediction model that is based on 11 predictors of lung cancer reduce sex disparities? This retrospective analysis of 883 lung cancer cases in the Chicago Race Eligibility for Screening Cohort (CREST) determined the sensitivity of USPSTF vsPLCOm2012 eligibility criteria, stratified according to sex. For comparisons vsthe USPSTF 2013 and the recently published USPSTF 2021 (released March 9, 2021) eligibility criteria, the PLCOm2012 model was used with risk thresholds of≥ 1.7%/6 years (6y) and≥ 1.0%/6y, respectively. The sensitivities for screening by the USPSTF 2013 were 46.7%for women and 64.6%for men (P= .003) and by the USPSTF 2021 were 56.8%and 71.8%, respectively (P= .02). In contrast, the PLCOm2012≥ 1.7%/6y sensitivities were 64.6%and 70.4%, and the PLCOm2012≥ 1.0%/6y sensitivities were 77.4%and 82.4%. The PLCOm2012 differences in sensitivity using≥ 1.7%/6y and≥ 1.0%/6y thresholds between women and men were nonsignificant (both, P= .07). Compared with men, women were more likely to be ineligible according to the USPSTF 2021 criteria because their smoking exposures were< 20 pack-years (22.8%vs14.8%; ORWomen vsMen, 1.70; 95%CI, 1.19-2.44; P= .002), and 27%of these ineligible women were eligible according to the PLCOm2012≥ 1.0%/6y criteria. Although the USPSTF 2021 eligibility criteria are more sensitive than the USPSTF 2013 guidelines, sex disparities in eligibility remain. Adding the PLCOm2012 risk prediction model to the USPSTF guidelines would improve sensitivity and attenuate sex disparities.

Inappropriate Use of Aspirin in Real-Life Cardiology Practice: Results from the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) Study.

Background: Indications and appropriateness of aspirin use have not been well investigated in Turkey.Aims: To investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting.Study Design: Cross-sectional study.Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) is a cross-sectional and multicenter study that included 5007 consecutive patients aged 18 or over who presented to 30 different cardiology outpatient clinics from 14 cities throughout Turkey. Only patients using aspirin (80-325 mg) were included. The study population was divided into 2 groups regarding the use of aspirin: primary prevention (PP) group and secondary prevention (SP) group. The indication of aspirin use was evaluated following the 2016 European Society of Cardiology (ESC) and the 2016 United States Preventative Services Task Force (USPTF) guidelines in the PP group.Results: A total of 5007 patients (mean age 62.15 ± 11.05, 39% female) were enrolled. The PP group included 1132 (22.6%) patients, and the SP group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71% of the patients according to the USPTF guidelines. Multivariate logistic regression analysis showed age OR: 0.98 CI (0.97-0.99) P = .037, smoking OR: 0.60 CI (0.44-0.82) P = .001, heart failure OR: 2.11 CI (1.14-3.92) P = .017, hypertension OR: 0.51 CI (0.36-0.74) P < .001, diabetes mellitus OR: 0.34 CI (0.25-0.47) P < .001, oral anticoagulant use OR: 3.01 CI (1.10-8.25) P = .032, and female sex OR: 2.73 CI (1.96-3.80) P < .001 were independent predictors of inappropriate aspirin use in PP patients.Conclusion: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in PP, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines. Besides, heart failure, oral anticoagulant use, and the female sex of the patients were independent predictors of inappropriate use of aspirin.

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.

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)

Differences in rates of low-dose computed tomography screening for lung cancer amongst various outpatient care centers.

245 Background: Despite low-dose computed tomography (LDCT) screening for lung cancer recommended by the United States Preventive Services Task Force (USPSTF) demonstrating a relative reduction in mortality, there remains low rates of testing nationwide. Yet studies are limited regarding specific differences in screening rates amongst various outpatient care settings. Methods: We performed retrospective chart reviews of patients followed by resident providers within an academic internal medicine residency program who met USPSTF guidelines for lung cancer screening between 2015-2020. This was conducted at three separate outpatient clinic sites including a state-funded academic institution, inner city community health center, and veteran affairs medical center. Data collection included patient demographic and smoking histories as well as rates of ordered and completed LDCT screening. Results: A total of 832 patients were identified as current or former smokers between the ages of 55 and 80 years: 320 from Hartford Hospital Community Health Center (HHCHC), 262 from University of Connecticut Health Center (UCHC), and 250 from the Veteran Affairs (VA) Medical Center. 85 (27%) of these patients from HHCHC, 84 (32%) from UCHC, and 56 (22%) from the VA met USPSTF eligibility criteria for LDCT screening. Overall compliance rates of screening were found to be 44% at HHCHC, 59.5% at UCHC, and 51.8% at the VA. Results are outlined in Table. Conclusions: Screening rates for lung cancer with LDCT remain low but have been steadily improving throughout the United States following new recommendations and increased awareness provided by multiple medical organizations. We sought to compare differences in compliance rates amongst various outpatient clinics within the same internal medicine residency program at University of Connecticut. Our findings demonstrate significant differences in LDCT screening for lung cancer between the program’s community health center versus its state and federally funded outpatient clinics. Automatic reminders to providers can potentially improve rates of lung cancer screening. Patients should also be educated about the importance of screening to improve adherence with imaging. [Table: see text]

Abstract 5776: Factors associated with low-dose CT lung cancer screening adherence in a high burden state

Abstract Background: Lung cancer is the leading cause of cancer death in the U.S. The burden of lung cancer varies substantially by region and state, primarily due to historical differences in the prevalence of cigarette smoking. As of 2013, the United States Preventive Services Task Force (USPSTF) recommends lung cancer screening (LCS) with low-dose computed tomography (LDCT) for those meeting eligibility criteria. Given the recency of this recommendation, studies regarding eligibility and participation are sparse. Identifying screening participation rates and subpopulations with lower participation is an essential first step for planning targeted interventions. Therefore, the purpose of this study was to examine LCS eligibility, utilization, and factors associated with self-reported adherence in Oklahoma, a state with a high smoking prevalence rate and low lung cancer survival rate. Methods: Starting in 2017, CDC released an optional Behavioral Risk Factor Surveillance System (BRFSS) module for LCS. Data from 596 LDCT eligible participants from the 2017 and 2018 Oklahoma BRFSS surveys were used for this study. This analysis was restricted to data from individuals eligible for screening based on USPSTF guidelines. Univariate analyses using Rao-Scott Chi-square tests were performed to test for differences in the characteristics of those screened and not screened. Weighted logistic regression models were conducted to examine the importance of independent variables in odds of LCS services. Results: Approximately 5.0% of Oklahomans were eligible for LCS. Only 11.31% (95% CI: 8.02, 14.60) of eligible Oklahomans reported participating in LCS. Asthma diagnosis (p=0.0327), chronic obstructive pulmonary disease (COPD) diagnosis (p&amp;lt;0.0001), and general health status (p=0.0141) were all significantly associated with screening participation; however, urban/rural status (p=0.091), insurance status (p=0.9272), veteran status (p=0.2508), multiple chronic conditions (p=0.0624), and current smoking status (p=0.5099) were not. After adjusting for age, socio-economic factors (income, education, race), asthma status and general health status, the odds of participating in LCS was higher (OR=2.85; 95% CI: 1.40, 5.76; p=0.0037) among those with COPD compared to those without COPD. After the same adjustments the odds of LCS, specifically for males, was even greater among individuals with COPD (OR= 5.86; 95% CI: 2.36, 14.57; p=0.0002) than those without COPD; however, this relationship was not true for females (OR= 0.75; 95% CI: 0.27, 2.08; p=0.5744). Conclusion: Despite the known benefits of LCS, utilization remains suboptimal among individuals in a high-risk state. State estimates and identification of factors associated with LCS adherence may help inform LCS interventions. Citation Format: Ami E. Sedani, Lance Ford, Laura Beebe. Factors associated with low-dose CT lung cancer screening adherence in a high burden state [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5776.