Abstract IA021: Balancing act: cancer control and equity through implementation and de-implementation
Authors: Tehranifar Parisa , Moise Nathalie , Shelton Rachel C. 
Published: December 2023

Promoting evidence-based cancer prevention and control may require de-implementation strategies, aimed at reducing or removing interventions that have been shown as ineffective, potentially harmful, lacking in demonstrated effectiveness, or offering only limited health benefits. De-implementation involves a range of actions, including scaling back these interventions, narrowing their application to specific populations or settings, substituting them with more effective alternatives, or entirely discontinuing them without replacement. The evolving nature of scientific evidence and the shifting landscape of population health priorities, which contribute to changing guidelines over time, make de-implementation an important component of the broader implementation science to advance cancer prevention, control, and equity. While the field is expanding, there remains a research gap in empirical studies that elucidate the factors influencing de-implementation or effective strategies for facilitating it. Emerging data indicate that the drivers of implementation and de-implementation often differ, necessitating distinct or adapted strategies, frameworks, and outcomes. Implementation and de-implementation approaches also have varying implications and considerations for addressing health disparities. Breast cancer screening through mammography serves as a case study, exemplifying an evidence-based practice marked by both underuse and overuse — corresponding to lower and higher guideline-recommended participation, respectively  — across different population groups and settings. In this educational session presentation, we will share the approaches and insights gathered from our efforts to promote appropriate screening mammography within racially and ethnically diverse and underserved communities. In this education presentation, we will highlight findings from our NIH-funded studies, focusing on two specific areas: breast density notification and mammography screening in older women. These areas represent current practices characterized by insufficient evidence regarding effectiveness, potential harms, and benefits, along with inconsistent clinical recommendations, illustrating the need for a more deliberate and well-informed approach to enhance breast cancer control and mitigate health disparities. Beyond illuminating some of the challenges at the policy, organizational, and provider levels, we emphasize the critical role that women or patients play in shaping the landscape of breast cancer screening. Their perspectives and experiences are crucial considerations when formulating de-implementation strategies aimed at optimizing breast cancer screening and promoting equity.

Citation Format: Parisa Tehranifar, Nathalie Moise, Rachel C. Shelton. Balancing act: cancer control and equity through implementation and de-implementation [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 IA021.