Use Of Screening Research Articles

Predictors of Breast Cancer Outcome in a Cohort of Women Seeking Care at a Safety Net Hospital

ObjectiveThis study aimed to identify predictors associated with lower mortality in a population of women diagnosed and treated for breast cancer at a safety net hospital. MethodsFrom 2008-2014, 1,115 patients were treated for breast cancer at our academic safety net hospital. 208 were excluded due to diagnosis at an outside facility, and the remaining 907 (81%) formed the study cohort. Retrospective charts and imaging reviews looked at race, ethnicity, insurance status, social determinants of health, screening utilization, treatment regimen, and 7-13-year follow-up care, including the cause of death. Multivariable logistic regression modeling assessed mortality, and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were computed. ResultsOf the 907 women, the mean age was 59 years (inter-quartile range 50-68 years), with 40% White, 46% Black, 4% Asian, and 10% Other. Increasing age (aOR=1.03, p=0.001) and more advanced stage at diagnosis (aOR=6.37, p<0.0001) were associated with increased mortality. There was no significant difference in mortality based on race or ethnicity (p>0.05). Of 494 with screening prior to diagnosis, longer screening time was observed for patients with advanced stage (median 521 days) vs. early stage (median 404 days), p=0.0004. Patients with Medicaid, insurance not specified, and no insurance were less likely to undergo screening before diagnosis than privately insured (all p<0.05). Shorter screening time was associated with lower all-cause mortality (aOR=0.57, 95% CI=0.36-0.89, p=0.013). DiscussionIn a safety net population, a more advanced stage at diagnosis was associated with higher mortality and lower odds of undergoing screening mammography in the two years prior to a breast cancer diagnosis. Early screening was associated with lower mortality. Finally, given no racial or ethnic differences in mortality, the safety net infrastructure at our institution effectively provides equitable cancer care once a cancer is confirmed.

GCM2 p.Tyr394Ser variant in Ashkenazi Israeli patients with suspected familial isolated hyperparathyroidism.

A germline mutation can be identified in up to 10% of patients with primary hyperparathyroidism (PHPT). In 2017, a high frequency of the GCM2 [(NM_ 004752.4) c.1181A> C; p.Tyr394Ser; rs142287570] variant was reported in PHPT Ashkenazi Jews (AJ). To evaluate the presence of the GCM2 p.Tyr394Ser variant in Israeli patients addressed for genetic evaluation to characterize their phenotype and clinical management. Patients with PHPT who underwent addressed for genetic screening for suspected familial hypocalciuric hypercalcemia (FHH), a family history of isolated hyperparathyroidism (FIHP), or failed parathyroidectomy with persistent PHPT were recruited. Those with normal initial selected gene sequencing or hyperparathyroid genetic panel completed the GCM2 p.Tyr394Ser variant sequencing. The prevalence of this variant was evaluated using our local genomic database. A total of 42 single individuals from unrelated kindreds were evaluated. A disease-causing mutation was found in 11 (26.1%) patients: 10 were diagnosed with FHH (eight CASR and two AP2S1 mutations), and one patient had a CKN2B mutation. In 28 of the remaining patients, the GCM2 p.Tyr394Ser variant was positive in three (10.7%), and all were AJ. Within AJ (15/28, 53.5%), the rate of the p.Tyr394Ser variant was 3/15 (20%), and of those, two had a history of familial isolated hyperparathyroidism. Multi-glandular parathyroid adenoma/hyperplasia was also observed in two of these patients. No clinical or laboratory findings could discriminate patients with the GCM2 p.Tyr394Ser variant from those with FHH. Cinacalcet normalized the calcium levels in one patient. The prevalence of the GCM2 p.Tyr394Ser variant in 15,407 tests in our local genomic database was 0.98%. In contrast to previous observations, the GCM2 p.Tyr394Ser variant-associated phenotype may be mild in AJ with FIHP, sometimes mimicking FHH. Because surgery may be curative, surgeons should be aware of the possibility of multiple gland diseases in these patients. The clinical spectrum and clinical utility of screening for this variant warrant further investigation.

Abstract C123: Racial and ethnic disparities in colorectal cancer screening utilization among adults with multiple chronic conditions: BRFSS 2012-2020

Abstract Introduction: Colorectal cancer (CRC) screening utilization remains suboptimal in the U.S. despite national guidelines, and disparities are evident across different racial and ethnic groups. Language barriers further pose significant obstacles to CRC screening in racial/ethnic minority populations. Individuals with multiple chronic conditions (MCC) are at higher risk of developing CRC, thus screening is vital in this high-risk population to improve CRC outcomes and the management of other chronic conditions. This study examines racial/ethnic and language differences in CRC screening utilization among individuals with varying numbers of MCC. Methods: Participants aged 50-75 years from the U.S. Behavioral Risk Factor Surveillance System (2012-2020) were included (n=989,830). Counts of nine conditions available in the BRFSS (asthma, diabetes, cancer, non-melanoma skin cancer, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, depression, and kidney disease), were categorized as none, 1, 2, 3, and ≥4 based on sample distribution. Self-reported CRC screening status was classified as up-to-date or not based on screening recommendations. Race/ethnicity groups included Hispanics completing the interview in Spanish as a limited English proficiency proxy (Hispanics with LEP), Hispanics without LEP, non-Hispanic Blacks (NHB), and non-Hispanic Whites (NHW). Adjusted prevalence ratios (aPRs) were estimated to evaluate the association between race/ethnicity and CRC screening among different counts of MCC using Poisson models. Models were adjusted for age, sex, health insurance, and survey year, and all findings were weighted to be representative of the broader US adult population aged 50-75 years. Results: Overall, 68.1% were aged 50 to 65 years, 52.2% were women, 76.4% were NHW and 66.5% were up-to-date with CRC screening. About one in seven had ≥4 MCC. Arthritis was the most common chronic condition among NHW, NHB, and Hispanics without LEP, while diabetes was the most common among Hispanics with LEP. Important differences were found in the association between being up-to-date with CRC screening and number of MCC across the different race/ethnicity subgroups. Higher proportions of Hispanic with LEP participants were not up-to-date with CRC screening compared to all other racial/ethnic groups. Hispanics with LEP had lower rates of up-to-date CRC screening across all MCC subgroups as compared to NHW (aPRno MCC: 0.67; 95% Confidence Interval (CI): 0.64-0.71; aPR≥4 MCC: 0.85; 95% CI: 0.79-0.91). Hispanics without LEP with 0, 1, or 2 MCC were less likely to be up-to-date for CRC screening compared to NHW. No statistically significant differences were found between NHB and NHW individuals. Conclusion: We found disparities among Hispanic with LEP, who had lower rates of up-to-date CRC screening compared to NHW, regardless of the number of MCC. Targeted interventions are needed to address these disparities and improve screening rates, particularly among Hispanics and with consideration for cultural and language barriers to CRC screening. Citation Format: Atinuke G. Oyinbo, Maira A. Castaneda-Avila, Mayra Tisminetzky, Kate Lapane. Racial and ethnic disparities in colorectal cancer screening utilization among adults with multiple chronic conditions: BRFSS 2012-2020 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C123.

Challenges in identification of HIV‐Associated Neurocognitive Disorders, a focus on low and middle income countries

AbstractBackgroundHIV‐associated neurocognitive disorders (HAND) are highly prevalent amongst people living with HIV (PLWH), especially in Sub‐Saharan Africa (SSA) where the majority of PLWH live. Current HAND identification measures lack accuracy in older PLWH on treatment, with substantial heterogeneity observed in SSA prevalence meta‐analyses There is a need to better understand the current cognitive phenotype of this newly emergent population, to develop appropriate screening tools. We report two linked studies.Study 1 compared diagnostic accuracy of the International HIV dementia scale (IHDS), and Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in TanzaniaStudy 2 aimed to identify cognitive domains significantly associated with symptomatic HAND (s‐HAND) in older PLWH in Tanzania, with potential utility in future screening measures.MethodA systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic underwent comprehensive HAND evaluation by consensus American Academy of Neurology (AAN) criteria including locally‐normed low‐literacy clinical neuropsychological assessment. A diagnostic accuracy study of the IHDS and IDEA screen versus AAN criteria was completed with strict blinding. Participants were offered identical annual reassessment at Y1 Y2 and Y3 and the relationship of cognitive domains with s‐HAND in a logistic mixed effects modelResultHAND was highly prevalent (47%) at baseline, increasing to 57.9% at year 3.At baseline, both IHDS and IDEA had limited diagnostic accuracy for HAND (AUROC 0.639–0.667 IHDS, 0.647–0.713 IDEA). On secondary analysis of longitudinal data, tests of verbal learning and memory, categorical verbal fluency, visual memory and visuoconstruction had AUROC &gt; 0.7 for s‐HAND (0.70 ‐ 0.72; p&lt;0.001 for all). Tests of visual memory, verbal learning and memory (delayed recall and recognition memory), psychomotor speed, language comprehension and categorical verbal fluency were independently associated with s‐HAND (p&lt;0.01 for all). Neuropsychological impairment pattern varied by education.ConclusionCurrent HAND screening tests no longer perform well in the new population of older PLWH in Africa. Tests most associated with s‐HAND include broad cortical and subcortical domains, some not included in existing HAND screening tests and vary by educational background. This should be considered in future HAND screening measure development.

Abstract A044: Screening and characterization of CD38 chimeric antigen receptors for the development of natural killer cell-based therapies

Abstract Background: CD38 is a transmembrane protein that is often overexpressed in multiple myeloma (MM) and other hematologic cancers. The success of anti-CD38 monoclonal antibodies, like daratumumab and isatuximab, in the treatment of MM supports the potential of CD38-targeting therapy candidates in development, including chimeric antigen receptor (CAR) engineered natural killer (NK) cells. Because CD38 is expressed on normal hematopoietic cells and other tissues, it is important to assess the affinity and epitope-specificity of the CD38-targeting moiety to limit potential on-target/off-tumor toxicities. To determine how different biophysical characteristics impact CAR activity, we identified a diverse panel of CD38-specific antibodies, which were shown to display a wide range of affinities and epitopes towards CD38 and converted these clones into CARs to evaluate their expression and target-specific and non-specific activation in a high-throughput (HTP) CD38-knockout (CD38 KO) Jurkat screen. Methods: Antibodies against CD38 were identified through hybridoma screening. Humanized mice were immunized with the extracellular domain of CD38, and lymphocytes from lymph nodes were fused with SP2/0 cells to generate hybridoma cells. Supernatants from single cell sorted hybridoma clones were screened against CD38+ and CD38 KO Jurkat cells and were assessed for affinity and epitope via surface plasmon resonance detection with the Carterra LSA. 96 unique clones were converted into CARs and transduced into CD38 KO Jurkat cells. CAR-expressing Jurkat cells were assayed for CAR expression and activation (via CD69 expression) when cultured overnight in the presence or absence of MM.1R target cells. Seven CARs were selected for additional characterization in primary NK cells. NK cells from healthy donors were expanded on our proprietary NKSTIM cell line, knocked out for CD38 using a CRISPR-Cas system, and transduced with CD38 CAR constructs. CD38 CAR NK-mediated cytotoxicity against MM.1S target cells was assessed by IncuCyte® S3 live cell analysis system. Results: Hybridoma screening identified many unique CD38-specific antibodies, displaying a wide range of affinities and epitopes towards CD38. Despite these biophysical differences, many of these antibodies, when converted to CARs, confer target-specific activity. Multiple epitopes on CD38 may be targeted and even low affinity antibodies were sufficient for target-specific CAR activation. Furthermore, the seven selected CAR candidates that were expressed in CD38 KO donor NK cells displayed potent in vitro target cell killing against MM.1S target cells. Conclusions: In summary, we have identified and characterized a range of CD38-specific antibodies. When converted into CARs, these targeting moieties mediate target-specific activation, despite differences in CD38 epitope and in affinity, demonstrating the utility of HTP CAR screening. Moreover, expression of the top seven CAR candidates in CD38 KO NK cells resulted in potent target cell killing, supporting further pre-clinical evaluation in relevant models. Citation Format: Emily N Kang, Jacinda T Chen, Bing Li, Kate Jamboretz, Nitin Patel, Daniel Bedinger, Kyle T Pratt, Jessica Hsieh, Luxuan TE Buren, Chao Guo, Ivan Chan, James B Trager, Sasha Lazetic. Screening and characterization of CD38 chimeric antigen receptors for the development of natural killer cell-based therapies [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor Immunology and Immunotherapy; 2023 Oct 1-4; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Immunol Res 2023;11(12 Suppl):Abstract nr A044.

Factors affecting antenatal screening for HIV in Nepal: results from Nepal Demographic and Health Surveys 2016 and 2022

ObjectivesAntenatal screening for HIV remains low in Nepal. Identifying factors associated with the uptake of antenatal screening is essential to increase uptake and prevent mother-to-child transmission (MTCT). This study investigated...

Abstract B107: Disparities in lung cancer screening rates: A retrospective observational study

Abstract Introduction: Lung cancer is a leading cause of cancer deaths worldwide. Despite advances in cancer care, the low five-year survival rate for lung cancer is due to late-stage diagnoses. Early detection through lung cancer screening is vital for improving patient outcomes. However, racial disparities persist, with Black individuals experiencing higher rates and advanced stages of the disease. This retrospective study assessed racial and gender disparities in lung cancer screening rates among different racial groups at WakeMed Health and Hospital outpatient primary care clinics. Study design: The study utilized data from the lung cancer screening registry, focusing on the period between Jan 1st 2017 and May 15th 2023. The data was obtained from the EPIC electronic medical record system and exported to Excel. We implemented filters to narrow down the patient population that met the U.S. Preventive Services Task Force inclusion criteria for lung cancer screening. Eligible patients for lung cancer screening are those aged 50 to 80 years, either current smokers or individuals who quit smoking within the past 15 years and have a smoking history of at least 20 pack years. The study focused on three racial groups: Asian, Black, and White populations. Results: Among the 2,098 patients who met the inclusion criteria, 15.5% were Black (n=326), 0.01% were Asian (n=23), and 83.4% were White (n=1,749). The screening rates for lung cancer were calculated for each racial group. The Asian population had a screening rate of 26% (6 out of 23 patients), the Black population had a rate of 32% (103 out of 326 patients), and the White population had a rate of 31% (543 out of 1,749 patients). Among the Asian population, the screening rate for Asian males was 20% (4 out of 20 patients), while for Asian females, it was relatively higher at 67% (2 out of 3 patients). For the Black male population, the screening rate was 31% (52 out of 167 patients), while among females, it was 32% (51 out of 159 patients). Among the White population, white males were screened at a rate of 33% (313 out of 962 patients), while among females, it was slightly lower at 29% (230 out of 787 patients). Conclusion: The findings reveal no significant difference in lung cancer screening rates between racial groups or genders. Caution must be exercised when interpreting the findings for the Asian population due to the small sample size. Further research using a larger and more diverse dataset is necessary to draw more robust conclusions regarding potential disparities in lung cancer screening rates. This study underscores the importance of improving overall lung cancer screening rates, as the majority of the eligible population did not receive screening. Efforts will be made to implement interventions that enhance lung cancer screening rates, ensuring timely detection and improving patient outcomes. Addressing disparities in lung cancer screening access and utilization is crucial for achieving equitable healthcare and reducing the burden of lung cancer on vulnerable populations. Citation Format: Giuseppina Jacob, Amanpreet Dhaliwal, Praveen Namireddy. Disparities in lung cancer screening rates: A retrospective observational study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B107.

Serotonin 2A Receptor (5-HT2AR) Agonists: Psychedelics and Non-Hallucinogenic Analogues as Emerging Antidepressants.

Psychedelics make up a group of psychoactive compounds that induce hallucinogenic effects by activating the serotonin 2A receptor (5-HT2AR). Clinical trials have demonstrated the traditional psychedelic substances like psilocybin as a class of rapid-acting and long-lasting antidepressants. However, there is a pressing need for rationally designed 5-HT2AR agonists that possess optimal pharmacological profiles in order to fully reveal the therapeutic potential of these agonists and identify safer drug candidates devoid of hallucinogenic effects. This Perspective provides an overview of the structure-activity relationships of existing 5-HT2AR agonists based on their chemical classifications and discusses recent advancements in understanding their molecular pharmacology at a structural level. The encouraging clinical outcomes of psychedelics in depression treatment have sparked drug discovery endeavors aimed at developing novel 5-HT2AR agonists with improved subtype selectivity and signaling bias properties, which could serve as safer and potentially nonhallucinogenic antidepressants. These efforts can be significantly expedited through the utilization of structure-based methods and functional selectivity-directed screening.

Cervical cancer screening utilization among women aged 30-49 years in Lampung, Indonesia

Background: Cervical cancer ranks second with a total of 36,633 cases or 9.2% of the total cancer cases in Indonesia. Cervical cancer patients in Indonesia have reached 23.4 per 100,000 population with an average death rate of 13.9 per 100,000 population.Purpose: To determine the relationship between perceptions of benefits, threats, and barriers to the interest in undergoing cervical cancer screening using the VIA method in women aged 30-49 years in Gedung Rejo Sakti Tulang Bawang Health Center in 2023.Method: Using a quantitative analytical method with a cross-sectional design. The total sample size was 70 people. The sampling method used was accidental sampling. Data analysis was performed using the chi-square test and multivariate analysis using multiple logistic regression.Results: There is a significant relationship between the perception of benefits and the interest in undergoing cervical cancer screening using the VIA method (P-value = 0.000; OR = 0.099), there is a significant relationship between the perception of threats and the interest in undergoing cervical cancer screening using the VIA method (P-value = 0.000; OR = 0.012), there is a significant relationship between the perception of barriers and the interest in undergoing cervical cancer screening using the VIA method (P-value = 0.000; OR = 0.108), the perception of threats is the dominant factor in determining the interest in undergoing cervical cancer screening using the VIA method (P-value = 0.000; OR = 95.782).Conclusion: All variables (perception of benefits, perception of threats, perception of barriers) are closely related to the interest in undergoing cervical cancer screening using the VIA method.Suggestion: Health center management should be more active in health promotion to increase the interest in undergoing cervical cancer screening using the VIA method in women aged 30-49 years.

Utilization of Early Intervention Among Children with Sickle Cell Disease

Background: The most prevalent monogenic disorder among children is sickle cell disease (SCD). SCD is the most common cause of pediatric stroke and is primarily inherited by people that identify as Black or of African descent. 1,2 Children with SCD have an elevated risk for delayed development and poor academic outcomes. 2 Our previous findings identified that 50% of children with SCD have a developmental delay, however, &amp;lt;5% were receiving therapy services. 3-5 Home-based programs have ameliorated cognitive and language delays in children with SCD. 6 In the United States, home-based therapy services (e.g., occupational, physical, and speech therapy) are provided through a federally mandated program called Early Intervention for free or reduced cost for children with developmental delay &amp;lt;3 years of age. 7 Unfortunately, this program is underutilized, especially in underserved and minoritized communities, with as few as 2% of eligible children receiving services. 8,9 Hematologists, who are tasked with providing ongoing medical care for young children with SCD, often lack the resources/tools needed to incorporate developmental screening into standard care. Thus, early indicators of developmental delay remain undetected and untreated, costing children and families precious time to intervene early. 6,10,11 This study aimed to assess the use of early intervention and determinants affecting participation in developmental screening and intervention among caregivers of children 0-4 years of age with SCD. Methods: We recruited caregivers with children under 4 years of age with SCD from clinics in St. Louis, Missouri and Memphis, Tennessee. Semi-structured interviews based on the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework were used to describe determinants for referral success and describe the mechanisms (barriers and facilitators) that influence early intervention program utilization. 12 Interviews included open-ended to address topics related to reach, perceived effectiveness, and likelihood of adoption of early intervention if recommended. Additional questions assessed caregiver knowledge of developmental delays in SCD and utilization of screening and intervention. Results: Among 127 caregivers identified as eligible, 47 consented and 20 completed an interview between September 2022 and February 2023. Similar to prior studies, over half of caregivers reported living in a low-income household, over half of children had hemoglobin SS and all participants identified as Black or African American. Interviews lasted between 15-75 minutes (mean = 34). Three themes emerged from the data including 1) Caregivers have not been informed about elevated risk for developmental delay, 2) Caregivers prioritize connecting with their provider and 3) Caregivers had not been adequately informed about early intervention services (Table 1). Conclusions: This study highlights the low utilization of early intervention services for young children with SCD. Caregivers expressed frustration with the lack of awareness regarding the elevated risk for developmental delays and prioritize that information coming from their specialty providers (e.g., sickle cell clinic). Additionally, inadequate information about available services contributes to underutilization. As healthcare providers, we are tasked with increasing awareness about the associated risks of SCD, integrating developmental screening into standard care, and providing caregivers with information that could improve developmental outcomes for children with SCD.

741. Assessing the Concordance of MRSA Carriage Screening with MRSA Infections

Abstract Background There is a lack of research on MRSA surveillance in children. This study focused on children with confirmed MRSA infections to determine the utility of MRSA screens in guiding empiric anti-MRSA treatment for children without history of MRSA infection. We examined the concordance of screens to assess for differences by infection type, and used statistical analysis to determine significant contributors to concordance. Methods Pediatric hospital patients admitted from 2002-2022 were included. Subjects had MRSA infections subsequent to a MRSA surveillance screen performed in the preceding year. Statistical analysis, namely multivariable and binomial regression, identified associations between MRSA screens and infections. Number needed to treat analysis calculated the utility of re-screening. Results Among 246 subjects, 39.0% had concordant screens. 151 (61.4%) screens were obtained in the two weeks preceding infection. Sensitivity for bacteremia was 50.0% (n=42), for ET/respiratory 44.4% (n=81), for SSTI 29.4% (n=102). For children under 6 months of age, sensitivity was 35.9% (n=78). Multivariable analysis significantly associated days since MRSA screening and decreasing likelihood of concordance. Binomial regression modeled the probability of concordance to drop below 50.0% for all infections after four days, after six days for bacteremia specifically, and twelve days for ET/respiratory infections. Probability of Concordance Over Time The probability of MRSA screening concordance over time based upon binomial prediction modeling. Each line represents the probability of concordance on a given day subsequent to MRSA screening. Number Needed to Treat (test) Analysis A theoretical control arm of patients receiving no re-screening is compared to a theoretical treatment arm receiving re-screening. Each column represents the number needed to re-screen (for a given number of days) to predict one MRSA infection. Absolute risk reduction is overlaid. Conclusion The concordance of screens was far lower than NPV found in past studies. Bacteremia concorded at 50.0%, ET/respiratory infections 44.4%, SSTI 29.4%. The number of days elapsed since MRSA screening proved the only significant covariate. When that covariate modeled the probability of screening concordance with infection, 7 days represented when the probability of concordance fell to or dropped below 50.0% for infection types. Only patients with a known MRSA infection were included in our study, and concordance of screens was far lower than NPV found in past studies; previous results may have been impacted by low prevalence to inform high NPV. We suggest that negative MRSA screens should not invalidate reasonable suspicion for MRSA infection in patients with high pre-test probabilities for infection. Re-screening patients may optimize concordance. Disclosures All Authors: No reported disclosures

The relationship of cancer history and chronic disease status to colorectal cancer screening: A cross-sectional analysis of 2020-2021 Behavioral Risk Factor Surveillance System.

We examined whether having a history of cancer and chronic diseases was associated with guideline-concordant colorectal cancer (CRC) screening utilization. Self-reported data from the 2020 and 2021 Behavioral Risk Factor Surveillance System in Oregon and West Virginia were used. Guideline-concordant CRC screening was the outcome of interest. The exposure was having a personal history of cancer, chronic diseases, or both. Multivariable logistic regressions were applied to assess the abovementioned association. Among 10,373 respondents aged 45-75years, 75.5% of those with a history of cancer and chronic diseases had guideline-concordant CRC screening use versus 52.8% of those without any history (p-value < 0.05). In multivariable analysis, having a history of cancer (OR 1.74; 95% CI 1.11-2.71), chronic diseases (OR 1.35; 95% CI 1.14-1.59), and both cancer and chronic diseases (OR 2.14; 95% CI 1.62-2.82) were positively associated with screening uptake compared to respondents without any history. Regardless of disease history, older age was associated with greater CRC screening uptake (p-value < 0.05). Among respondents with chronic diseases only or without any condition, those with a health care provider had 1.7-fold and 2.7-fold increased odds of receiving CRC screening, respectively. However, current smokers were 28% and 34% less likely to be screened for CRC among those with chronic diseases only and without any conditions, respectively. Having a personal history of cancer and chronic diseases appears to be positively associated with guideline-concordant CRC screening use. Effective implementation of patient-centered communication through primary care initiatives may increase adherence to CRC screening recommendations.

Factors Influencing Cervical Cancer Screening in Women Referring to the Therapeutic Centers of Tehran: A Cross-sectional Analysis

Cervical cancer is the second most common cancer in women; screening intervals are the basis of early diagnosis. Moreover, this study was conducted in Tehran, considering the importance of cervical cancer screening for diagnosing this cancer and the lack of sufficient information about the factors related to cervical cancer screening in women. However, this paper studies the extent of screening behaviors and factors influencing it in cervical cancer. This descriptive and analytical paper established the target population of 384 women of different ages who refer to healthcare centers in Tehran. The purpose of data collection was based on the researcher's questionnaire based on the studies and data of the patients registered in Shariati Medical Center in Tehran, whose reliability was confirmed by the test (Cronbach's Alpha= 0.7). Furthermore, data was analyzed by SPSS and Smart PLS. This paper reveals that six factors influence the direct effect of cervical cancer screening. However, the factors include personal hygiene, psychological, pap smear test screening, colposcopy screening, social factors, and Health Care Utilization—the existing observation aimed to assess the influence of risk factors of cervical cancers. Accordingly, most cervical cancers may be diagnosed with previous knowledge of threat factors. Identification of excessive–risk populations and beginning early screening are influential in the early recognition of cervical cancers.

Prenatal aneuploidy screening in a low-risk Hispanic population: price elasticity and cost-effectiveness

Background: In October 2015, the Massachusetts Medicaid program temporarily stopped reimbursing the ICD-10 code used by certain communities for serum aneuploidy screening. This change resulted in a substantial number of patients without aneuploidy screening for approximately three years.Objective: To determine the change in utilization and cost-effectiveness of prenatal aneuploidy serum screening in a low-risk Hispanic Medicaid population in Massachusetts.Study Design: We conducted a retrospective chart review of Spanish-speaking pregnant patients under 35 years of age receiving aneuploidy serum screening at a Massachusetts community health center. The study compared aneuploidy serum screening rates before and after May 2016, when the Massachusetts Medicaid program, MassHealth, temporarily discontinued reimbursement for the screening. Based on these rates, we developed a Markov cohort simulation model to assess the economic value of reimbursed aneuploidy screening versus non-reimbursed or limited screening. Clinical outcomes included trisomy 21, live births, and therapeutic abortions for a trisomy 21 diagnosis. Economic outcomes included discounted quality-adjusted life years and lifetime medical costs, net health benefit, and incremental cost-effectiveness ratios.Results: Before the MassHealth policy change, 69% (55/80) of pregnant individuals selected quad or sequential screens, compared to 9% (10/112) post-policy change. Traditional aneuploidy serum screening in a low-risk (aged <35 years) Hispanic population was considered cost-saving (i.e., resulted in lower incremental costs and higher incremental benefits compared to non-reimbursed or limited screening).Conclusions: From a U.S. healthcare payer perspective, aneuploidy serum screening for Hispanic pregnant individuals under 35 years of age is economically advantageous compared to limited screening.

Correction: Cervical cancer screening utilization and predictors among eligible women in Ethiopia: A systematic review and meta-analysis

Correction: Cervical cancer screening utilization and predictors among eligible women in Ethiopia: A systematic review and meta-analysis

Geographic Variation in Late-Stage Cervical Cancer Diagnosis

There are stark disparities in cervical cancer burden in the United States, notably by race and ethnicity and geography. Late-stage diagnosis is an indicator of inadequate access to and utilization of screening. To identify geospatial clusters of late-stage cervical cancer at time of diagnosis in Texas. This population-based cross-sectional study used incident cervical cancer data from the Texas Cancer Registry from 2014 to 2018 of female patients aged 18 years or older. Late-stage cervical cancer cases were geocoded at the census tract level (n = 5265) using their residential coordinates (latitude and longitude) at the time of diagnosis. Statistical analysis was performed from April to September 2023. Census tract of residence at diagnosis. Late-stage cervical cancer diagnosis (ie, cases classified by the National Cancer Institute Surveillance, Epidemiology and End Results summary stages 2 to 4 [regional spread] or 7 [distant metastasis]). A Poisson probability-based model of the SaTScan purely spatial scan statistics was applied at the census tract-level to identify geographic clusters of higher (hot spots) or lower (cold spots) proportions than expected of late-stage cervical cancer diagnosis and adjusted for age. Among a total of 6484 female patients with incident cervical cancer cases (mean [SD] age, 48.7 [14.7] years), 2300 (35.5%) were Hispanic, 798 (12.3%) were non-Hispanic Black, 3090 (47.6%) were non-Hispanic White, and 296 (4.6%) were other race or ethnicity. Of the 6484 patients, 2892 with late-stage diagnosis (mean [SD] age, 51.8 [14.4] years were analyzed. Among patients with late-stage diagnosis, 1069 (37.0%) were Hispanic, 417 (14.4%) were non-Hispanic Black, 1307 (45.2%) were non-Hispanic White, and 99 (3.4%) were other race or ethnicity. SaTScan spatial analysis identified 7 statistically significant clusters of late-stage cervical cancer diagnosis in Texas, of which 4 were hot spots and 3 were cold spots. Hot spots included 1128 census tracts, predominantly in the South Texas Plains, Gulf Coast, and Prairies and Lakes (North Texas) regions. Of the 2892 patients with late-stage cervical cancer, 880 (30.4%) were observed within hot spots. Census tract-level comparison of characteristics of clusters suggested that hot spots differed significantly from cold spots and the rest of Texas by proportions of racial and ethnic groups, non-US born persons, and socioeconomic status. In this cross-sectional study examining geospatial clusters of late-stage cervical cancer diagnosis, place-based disparities were found in late-stage cervical cancer diagnosis in Texas. These findings suggest that these communities may benefit from aggressive cervical cancer interventions.

Toxicological profile using mass-spectrometry in sudden cardiac arrest patients

Abstract Background Many drugs are known to increase the risks of ventricular arrythmias and sudden cardiac death, and current guidelines recommends collection of a blood sample at presentation for toxicological testing. To our knowledge, a broad toxicological analysis based on liquid-chromatography combined with high-resolution mass spectrometry (LC-HRMS) has not previously been performed in a resuscitated sudden cardiac arrest (SCA) cohort. Purpose We aimed to determine the qualitative and quantitative drug composition present in a well-defined SCA population by using a forensic toxicology approach for prescribed, non-prescribed, and recreational drugs, and further investigate whether these drugs were in therapeutic or toxic levels. Methods This study comprised a series of SCA patients (age 18-90 years) admitted to a cardiac intensive care unit in 2019-2020 in Denmark. Data from the SCA hospitalization was collected from the medical reports, including clinical characteristics and drugs prior to the blood sample was drawn. Drugs used during resuscitation were identified in each patient and excluded. Mass-spectrometry based toxicological analyses were performed to determine the absence or presence of any drugs and drug quantification. Results Of the 186 prospectively enrolled SCA patients (median age 62 years [IQR 54-72], 83% men), 167 (90%) had a shockable rhythm, and the majority (n=122, 66%) were caused by ischemic heart disease. We identified 92 different drugs (excluding metabolites), where each patient had a median of 2 detected drugs (IQR: 1-4). A total of 34 (18%) patients did not have any drugs detected. The most frequent drugs detected were analgesics or non-steroidal anti-inflammatory drugs (NSAID) (n=68, 37%), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (n=45, 24%), and beta-blockers (n=42, 23%). We detected QT-prolonging drugs in two of three patients with long QT-syndrome, and in both cases the QT-prolonging drug were considered the triggering factor of SCA. Moreover, polypharmacy (≥5 drugs) was common (n=37, 20%), excluding caffeine that was detected in 184 patients (99%). The drug combinations were often analgesics/NSAID, or beta-blockers combined with other drugs. A total of 32 (17%) patients had one or more recreational drugs detected, with the most common being opioid agonists in 14 patients. Importantly, none had toxic concentrations of any drugs. Conclusion We found that 82% had at least one drug detected at SCA, and polypharmacy was displayed in a considerable proportion. Potentially abusable drugs were encountered in 17%. We did not identify any occult overdose related cardiac arrests among resuscitated SCA patients, but in some patients, drugs were considered a contributing factor of SCA. When evaluating the utility of toxicological screening, it would in our setting (90% shockable primary rhythm) not be beneficial to screen SCA patients who are not suspected overdosed.

Abstract 12687: Evaluating a Coronary Artery Disease Polygenic Risk Score Screening Strategy in a Diverse Patient Cohort at UCLA

Introduction: Recent efforts to predict and mitigate coronary artery disease (CAD) risk have incorporated polygenic risk scores (PGS). Few studies examine the clinical impact of these PGS screening strategies or quantify their performance in clinical terms. Here we estimate the number needed to screen (NNS) of a PGS screening strategy for CAD based using a diverse electronic health record (EHR) linked biobank at UCLA Health. Methods: We leveraged longitudinal EHR data to conduct a synthetic trial. We assumed PGS screening was performed on 6/1/2013 for patients established prior to 1/1/2013 or 6 months into follow time if established later. Patients with preexisting cardiovascular disease or strong statin indications (LDL &gt; 190, diabetes or already on statins) are excluded. Patients with PGS scores in the top 5% of their genetic ancestry groupings (European, East Asian, African, Hispanic) are assumed to have been started on statins for the median 6.9 years of follow up. CAD diagnosis during follow up time was determined by ICD codes. NNS to prevent one CV event is calculated from cohort size and events assuming a statin number needed to treat of 50. Results: Of 33,789 adults, 17,074 were low risk and eligible for PGS screening (35% male with a mean age of 44). NNS to detect one CAD diagnosis was 351, 359, 814, 159 in the European, Hispanic, East Asian and African ancestry groups and NNS to prevent one cardiovascular event was 17,550, 17,950, 40,700, 7,950 respectively. Conclusion: Although PGS accuracy is lower in African ancestry individuals as compared to Europeans, the clinical utility of this PGS-based screening is highest in African ancestries due to increased baseline rates of disease in the African genetic ancestry grouping. Our results demonstrate that PGS accuracy is distinct from clinical utility of PGS-based strategies. Evaluation of screening strategies rather than accuracy alone will be required before PGS screening implementation.

Self-Sampling for Human Papillomavirus Testing: Acceptability in a U.S. Safety Net Health System

Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and experiences with mailed self-sampling kits for human papillomavirus testing among underscreened patients in a safety net health system. A nested telephone survey was administered between 2021 and 2023 to a sample (n=272) of the 2,268 participants enrolled in the Prospective Evaluation of Self-Testing to Increase Screening trial. Trial participants include patients of a safety net health system aged 30-65 years who were not up to date on screening. Participants were asked about barriers to provider-performed screening. Kit users and nonusers were asked about their experiences. Prevalent barriers to provider-performed screening included perceived discomfort of pelvic examination (69.4%), being uncomfortable with male providers (65.4%), and embarrassment (57.0%). Among participants who reported using the mailed kit (n=164), most reported good experiences (84.8%). Most reported self-sampling as more/equally convenient (89.0%), less/equally embarrassing (99.4%), and less/equally stressful (95.7%) than provider-performed screening. Among kit nonusers (n=43), reasons for not using the kit included forgetting about it (76.7%), preferring provider-performed screening (76.7%), and fearing cancer (67.4%). Prospective Evaluation of Self-Testing to Increase Screening trial participants generally had a positive experience with self-sampling for human papillomavirus testing. Increased comfort and reduced embarrassment/anxiety with self-sampling are relevant attributes because these were the most prevalent reported barriers to provider-performed screening. High acceptability suggests potentially high uptake when self-sampling for human papillomavirus testing receives regulatory approval and is available in safety net health systems.

Clinical Utility of Monoclonal Gammopathy Screening in the Evaluation of Anemia

Background Screening for monoclonal gammopathy (MG) is often performed in the evaluation of anemia. While certain MGs may be associated with anemia, these are rare conditions. Monoclonal gammopathy of undetermined significance (MGUS; prevalence of 8% among age &amp;gt;50 years) is common, but rarely causes anemia in isolation. Therefore, abnormal results from MG screening may be unrelated to patient symptoms and result in both financial and psychological harm. Limited data exist to guide clinicians regarding the utility of MG testing for anemia. Aims This study aims to describe both the clinical utility of MG screening during the evaluation of anemia and the most common etiologies for anemia in patients whose workup included MG screening. Methods We reviewed medical records of patients who received MG screening to evaluate anemia at Mayo Clinic in 2021. Patients with a previously diagnosed MG were excluded. MG testing included serum protein electrophoresis and free light chain assessments. The following data were extracted: hemoglobin, hematocrit, mean corpuscular volume (MCV), calcium, creatinine, eGFR, and the final hematologic diagnosis related to the monoclonal protein. Clinician documentation was evaluated to determine the attributed etiology of anemia. Results Among the 271 patients with anemia who were screened for MG, 33 (12.2%) were found to have a newly diagnosed MG. Only 2 patients screened for MG were ultimately found to have anemia caused by MG. These included a case of multiple myeloma and one patient with cold agglutinin disease and secondary hemolysis. In all patients screened, their anemia was ultimately thought to be due to iron deficiency (31.7%), B12 deficiency (3.0%), anemia of chronic disease (ACD)/inflammatory anemia (14.4%), chronic kidney disease (CKD) (3.7%), hemolysis (1.5%), hypogonadism (1.9%), idiopathic (21.0%), multifactorial: iron deficiency + ACD/inflammatory (3.0%), multifactorial: nutritional; iron deficiency + B12 deficiency (3.0%), multifactorial: ACD + CKD (5.2%), multifactorial: iron deficiency + CKD (1.8%), multifactorial: not otherwise specified (NOS) (6.6%), medications (0.4%), and other (2.6%). Both patients with newly diagnosed MG associated anemia presented with peripheral neuropathy as their primary symptom. Among these 2 patients diagnosed with dysproteinemia associated anemia, only one (0.4%) was placed on therapy for their MG. Summary/Conclusions In the evaluation of anemia, routine MG screening has low clinical utility. Less than 1 in 100 patients were found to have anemia attributable to MG. Furthermore, only 0.4 in 100 patients received MG-directed therapy. Most patients screened with SPEP for undifferentiated anemia were found to have anemia attributable to common causes including iron/nutritional deficiency, inflammatory processes, and CKD. Most patients with undifferentiated anemia would benefit from an anemia evaluation that focuses on the most common causes up front. Given the cost to healthcare and potential psychological harm to the patient of incidental MG diagnosis, further study is warranted to guide clinicians and limit the ordering of MG testing to individuals who are most likely to derive benefit.