bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of HPV vaccination in Florida compared to New York.
Authors: Neerukonda Thanuja , Makani Neeharika Srivastava , Patel Dhruv 
Published: June 2023

10544 Background: HPV is responsible for cancers including anus, penis, vulvovaginal, and oropharyngeal but cervical cancer is the most common cancer caused by HPV. To study the impact of HPV vaccination, we compared age-adjusted cervical cancer incidence and death rates in New York, a state with a high HPV vaccination rate, to Florida, a state with a lower vaccination rate, prior to HPV vaccination and 10 years post HPV vaccination availability. Methods: This is an ecologic study observing the cervical cancer incidence and death rates prior to (2005) and after (2016) the introduction of the HPV vaccination using state wide healthcare cancer registries. Results: The HPV vaccine became available in the United States in 2006. Historically, Florida was found to have a low HPV vaccination rate in 2009 with less than 40% compared to New York which had a high rate of 50% in 2009. By 2016, Florida’s HPV vaccination rate improved to 55% but was still low compared to New York with a rate greater than 70%. New York had a decline of cervical cancer incidence of 9.7 per 100,000 in 2005 to 8.3 in 2016. New York had a decrease in death rate from 3.0 in 2005 to 2.7 in 2016. In Florida, the cervical cancer incidence rate from 2005 to 2016 increased from 9.7 to 9.9 and the mortality was 3.0 in 2005 and 2.9 in 2016. When comparing New York’s cervical cancer incidence rates, there was a statistically significant drop in age-adjusted incidence before HPV-vaccination compared to 10 years post vaccination availability. When analyzing cervical cancer incidence in 2016, significant increase in cases between Florida’s incidence compared to New York’s. Conclusions: Since the introduction of the HPV vaccination, age-adjusted incidence rate of cervical cancer has declined in New York but not in Florida. This may be due to lagging HPV vaccination rates in Florida in addition to other sociodemographic or healthcare factors. There has been minimal change in cervical cancer death rates between both states, likely attributed by the low death rate associated with cervical cancer. The medical community needs to work together to address the barriers to HPV vaccination and promote programs to increase vaccination rates which will reduce the incidence and mortality of cervical, anus, penis, vagina, vulva, and oropharyngeal cancer. [Table: see text]
Training oncologists (Oncs) to conduct better informed discussions with African American (AA) cancer (CA) patients (pts) about tumor genomic profiling (TGP): Results of a randomized pilot trial of gene pilot pro (GPP).
Authors: Hall Michael J. , Hoadley Ariel , Chertock Yana , Kelly Patrick J , Singley Katie J , Luck Caseem C , Bass Sarah B 
Published: June 2023

10552 Background: Molecular characterization of tumors to guide therapy choices using next-generation sequencing-based TGP has become standard practice for pts w/multiple CA types. AAs are more likely to have negative attitudes towards genetics, rooted in concerns about privacy, cost and discrimination, and higher mistrust of medical institutions. Oncs are poorly prepared for informed discussions w/CA pts about secondary hereditary risks of TGP and often fail to have these conversations despite 2015 ASCO guidelines benchmarking this standard, and further are poorly informed of the potential challenges of discussing TGP and germline risk w/their AA CA pts. Methods: Formative work included 1-on-1 interviews (n = 10) to assess oncs’ perceptions of TGP use and discussions w/AA CA pts, and a national survey (n = 50) to assess TGP practice patterns, communication of hereditary risk, and challenges encountered in AAs. Interviews/survey data and advisory board input informed development of GPP, a 12 min online training video to improve Oncs’ awareness of ASCO guidelines, confidence and preparation to have TGP discussions w/pts, and improve awareness of barriers to TGP unique to AA CA pts. The control consisted of 10 slides with information about TGP drawn from industry/academic websites and the 2015 ASCO guidelines. Participants (n = 63) completed baseline (100%), post-intervention (100%), and 1-month (95%) follow-up surveys. The study was approved by the Fox Chase Cancer Center IRB 18-8006. Results: Oncs were recruited by email and randomized to view GPP or control material. The majority were age 40-49 (38%), 71% male, 44% White, w/mean 15 yrs in practice; 85% reported none or only informal training to communicate TGP risks/results to pts. GPP produced a durable increase in recognition of 4 core ASCO guideline elements (20% baseline, 67% post, 63% 1 month). At 1-month follow-up, GPP significantly improved recognition of barriers specific to AA CA pts related to TGP and hereditary risk (p = 0.001) and promoted greater preparedness to support TGP discussions w/AA pts including preparedness to identify (p < 0.01) and understand (p < 0.01) issues that matter most to their AA pts. 1-month confidence to conduct difficult discussions related to genetic mistrust (p = 0.004) and TGP cost (p = 0.003) was better preserved after viewing GPP compared to control. Among Oncs viewing GPP, 90% agreed/strongly agreed that GPP helped them “better understand how to address concerns my AA pts may have about TGP” and 97% definitely/probably would recommend GPP to other Oncs. Conclusions: GPP significantly improved Oncs’ awareness of barriers related to TGP communication in AA CA pts, improved preparedness to facilitate informed decision-making, and supported sustained confidence to lead difficult discussions.
Comparative overall survival of patients in trials of CKD4/6 inhibitors in combination with endocrine therapy in advanced breast cancer.
Authors: Kappel Coralea , Elliott Mitchell , Kumar Vikaash , Nadler Michelle B. , Desnoyers Alexandra , Amir Eitan 
Published: June 2023

1056 Background: CDK4/6i and endocrine therapy (ET) are an international gold standard therapy in estrogen receptor (ER) positive and HER2-negative advanced breast cancer (aBC). Individual trials of abemaciclib, palbociclib and ribociclib show similar impact on progression-free survival yet differing statistical significance for OS. A robust comparative evaluation of the efficacy, safety, and tolerability of the three drugs is warranted. Methods: We searched PubMed, ASCO, ESMO and SABCS proceedings to identify phase 3 randomized clinical trials reporting OS of CDK4/6i in combination with ET in ER-positive aBC in first or second line. A network meta-analysis using WinBUGS was performed to evaluate comparative efficacy, based on the ET partner, in the absence of direct comparisons. Trial level data on common and serious adverse events (AE) were extracted for each drug. The odds ratio (OR) for each AE was calculated comparing each CDK4/6i to the respective endocrine therapy backbone (aromatase inhibitor (AI) or fulvestrant) alone. Results: Seven studies comprising 4087 patients met the inclusion criteria. Median follow up was 70.2 months. Four studies paired a CDK4/6i with an AI or tamoxifen, 3 studies were paired with fulvestrant. There were no statistically significant differences in OS between any of the CDK4/6i with any ET backbone. Compared to palbociclib, ribociclib and abemaciclib showed significantly lower grade 1-2 fatigue/asthenia (ribociclib OR 0.69 [95% CI 0.58, 0.83]; abemaciclib OR 0.6 [95% CI 0.49, 0.74]) and abemaciclib showed significantly lower grade 1-2 alopecia (abemaciclib 0.76 [95% CI 0.6, 0.97]). Compared to palbociclib, ribociclib and abemaciclib showed significantly higher GI toxicity (ribociclib any grade vomiting OR 1.71 [95% CI 1.36, 2.15]; abemaciclib any grade vomiting OR 2.1 [95% CI 1.61, 2.62], any grade diarrhea 13.2 [95% CI 10.31, 16.78]). Treatment discontinuation was highest with abemaciclib. Conclusions: In this network meta-analysis, there was no statistically significant difference in OS between CDK4/6i despite differences in individual trials. Real-world data analyses may help to identify if a there is a meaningful inter-drug difference in efficacy. Significant differences between CDK4/6i are observed for safety and tolerability outcomes. [Table: see text]
Assessing disparities in lung cancer screening eligibility among high-risk individuals.
Authors: Gudina Abdi , Kamen Charles Stewart , Gilmore Nikesha , Kehoe Lee , Cupertino Ana Paula 
Published: June 2023

10563 Background: Low-dose computerized tomography (LDCT) scanning confers a 20% reduction in lung cancer mortality by diagnosing the disease at earlier, more treatable stages. Racial/ethnic minorities have historically been less likely to be eligible for lung cancer screening. In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its 2013 guideline for lung cancer screening eligibility by reducing the minimum age (55 to 50) and decreasing the cumulative number of cigarette pack-years smoked (30 to 20). The purpose of this study was to assess if the updated guideline will mitigate disparities in lung cancer screening eligibility among high-risk individuals. Methods: Data were obtained from the Behavioral Risk Factor Surveillance System (2017-2019), a population-based survey administered annually by the Centers for Disease Control and Prevention. Only subjects with complete information on the variables used to determine eligibility (age, smoking status, age at first start smoking, age at last smoked, average number of cigarettes smoked each day) (n = 793,537) were included in the final analysis. Logistic regression was used to model the association between predictors and 2021 vs. 2013 lung cancer screening eligibility. Results: Based on the 2013 guideline, Non-Hispanic Blacks (OR: 0.34; 95%CI: 0.31 - 0.38), Hispanics (OR: 0.12; 95%CI: 0.10 – 0.14), and other racial/ethnic minorities (OR: 0.59; 95%CI: 0.54 – 0.64) were less likely to be eligible for lung cancer screening than Non-Hispanic Whites. Using the 2021 guideline, Non-Hispanic Blacks (OR: 0.45; 95%CI: 0.42 - 0.49), Hispanics (OR: 0.15; 95%CI: 0.13 – 0.16), and other racial/ethnic minorities (OR: 0.63; 95%CI: 0.58 – 0.67) remain less likely to be eligible for lung cancer screening than Non-Hispanic Whites. Conclusions: The 2021 guideline slightly reduces racial/ethnic disparities in lung cancer screening eligibility. Further efforts should be made to develop a guideline that better addresses disparities in lung cancer screening eligibility to reduce lung cancer deaths in racial minorities.
Colorectal cancer and digital/live screening navigation: Promoting prevention through personalized recommendations and access.
Authors: Newcomer Kim , Goodman Andrea , Klein Marcie , Guevara Alex , Anderson Montel , Kufuor Nana 
Published: June 2023

10566 Background: This project evaluates the effectiveness of an advocacy organization-led digital and live navigation framework aimed at colorectal cancer (CRC) screening completion. The Colorectal Cancer Alliance’s screening quiz guides patients to a clinically valid, personalized CRC screening recommendation with a handoff to live navigation for those at risk. The framework utilizes digital innovation, targeted awareness, and financial support to support populations experiencing the greatest disparities and increase screening intention, behavior, and further health equity in colorectal cancer. This simple intervention is critical due to existing research consistently indicating on-time screening for CRC leads to favorable outcomes. Methods: In July 2022, the Alliance launched an enhanced quiz to improve the CRC screening navigation experience and increase engagement. The new survey instrument was restructured to streamline time to completion while preserving clinically accurate risk stratification. The follow-up navigation protocol was reordered from digital-first to live-first to leverage high-touch strategies earlier in the screening journey and dynamic content was added to the recommendation page to create a more personalized resource. The Alliance also deployed social media and influencer campaigns to increase outreach to at-risk communities. Results: The enhanced quiz delivered over 8,300 CRC screening recommendations and improved the average monthly completion rate (33%) and contact capture rate (14.4%) compared to the previous quiz in 2022 (24%; 8%). The median age of respondents was 55, and 37.2% of the respondents were between the ages of 45 and 64. Of the respondents, 26.7% were male and 73.3% were female. The majority were White (77.1%), 7.3% identified as Black/African American, 5.5% were Hispanic or Latino, and 3% were Asian. Most respondents were symptomatic (67.8%) but 8.1% were asymptomatic high-risk. Respondents (1,078) were triaged to live Alliance patient navigation. Conclusions: This digital and live navigation framework may serve as a strong solution in driving colorectal cancer screening and supporting shared-decision making conversations compared to other available interventions. The framework provides users with robust access to live navigation, educational resources, and support services for CRC screening and diagnosis. The Alliance is uniquely positioned to utilize its communications channels, social media and influencer campaigns to reach at-risk communities with credibility. Data attributed to specific campaigns are still being analyzed, and the Alliance will continue to optimize its navigation protocol and awareness efforts as quality improvement processes allow for a deeper understanding of more inclusive and impactful navigation experiences to close screening gaps among at-risk populations.
Navigation program for LDCT lung cancer screening implementation: A quality initiative.
Authors: Shrestha Jasmine , Reddy Aswanth , Nwankwo Nkolika 
Published: June 2023

10568 Background: Lung cancer remains the leading cause of cancer-related death worldwide. Despite recommendations from experts, the lung cancer screening has not been well adopted in practice. Methods: We started a pilot program in our cancer center in collaboration with Pulmonary medicine in November 2021 as we identified that the rates of Low Dose CT scan (LDCT) are meager in our community. Two areas that needed attention were identified. The first was the need for shared decision-making by the primary care physician (PCP) before ordering LDCT. The second was the follow-up for patients with positive lung nodules. A lung nodule patient navigator was assigned exclusively for this initiative. Reports were obtained from EPIC every month to identify patients who fit the criteria. PCPs of the respective patients were then reminded to discuss LDCT in the upcoming visit. The lung nodule navigator then followed the ordering and test results of LDCT. A dedicated lung nodule conference discussed all patients with positive lung nodules. Follow-up interventions included referrals to pulmonology, interventional radiology, or further imaging with PET scan. Per guidelines, patients who did not need acute intervention were kept on track for their follow-up CT as recommended. Results: We reviewed our baseline performance in LDCT from January to June 2021.The total screening included 271(32%) patients compared to 836 eligible patients who fit the criteria. From January 2022 to June 2022, out of 749 eligible patients who were expected to meet their PCP, 574(76%) patients received LDCT. Of the patients screened, 436(75%) had their baseline CT chest, with the remaining patients having follow-up CT. Fifteen patients had findings needing immediate intervention. Conclusions: The USPSTF has updated its annual lung cancer screening guidelines with LDCT for adults aged 50 to 80 years who have a 20-pack-year smoking history and current smoker or have quit within the past 15 years. With our approach, the screening rates have more than doubled compared to previous year. LDCT does carry certain risks, including false positive results and unnecessary biopsies; hence shared decision-making is needed before ordering the test. We identified the shared decision process as the rate limiting step across our institution. Our contact with PCP was a significant intervention that improved the screening. The second obstacle was the follow-up for positive LDCT, and we alleviated it with the multidisciplinary lung nodule conference. This process is undoubtedly difficult to achieve without a lung nodule navigator. Each hospital system is unique and has various difficulties implementing screening guidelines. We show that, with the help of a lung nodule navigator, the rates of lung cancer screening can be significantly increased.
The probability of lung cancer in patients with incidentally detected pulmonary nodules detected via low-dose computed tomography screening in China.
Authors: Lan-Wei Guo , Lyu Zhangyan , Zhang Shaokai 
Published: June 2023

10569 Background: Low dose computed tomography (LDCT) screening has been proven to be effective in reducing lung cancer mortality, but the ensuing high false-positive and overdiagnosis rates shackle the effectiveness of lung cancer screening (LCS) in China. Nodule malignancy prediction models may be an applicable solution. Methods: We developed and internally validated the model using data from the ongoing Henan province Cancer Screening Program in Urban China (CanSPUC). From 2013 to 2021, 23031 heavy smokers underwent baseline screening with LDCT; 2553 participants were diagnosed with pulmonary nodules. Detailed questionnaire, physical assessment and follow-up were completed for all participants. We then externally validated the model using the National Lung Screening Trial (NLST) dataset consisting of 10485 lung nodules in 4660 participants. Multivariable Cox proportional risk regression models were used. Data analysis was performed from July 1, 2022, through December 31, 2022. Results: A total of 111 and 1089 lung cancer cases with a median follow-up duration of 3.7 years occurred in the Henan CanSPUC and NLST study, respectively. Age, gender, physical activity, consumption of pickled food, history of silicosis or pneumoconiosis, nodule type, size, calcification, and pleural retraction sign were included into the model. The AUC (95% CI) of the model for 5-year lung cancer risk was 0.857 (0.801, 0.914) and 0.847 (0.829, 0.881) in the training set and validation set, respectively. Compared with Mayo model, VA model, PKU model, and Brock model, the Henan CanSPUC model yield statistically better discriminatory performance (all P values < 0.05). The model calibrated well across the deciles of predicted risk in both the overall population and all subgroups. Conclusions: The model developed and validated in this study may be used to estimate the probability of lung cancer in nodules detected at baseline LDCT, allowing more efficient risk-adapted follow-up in population-based LCS programs.
Assessing the risk of gastrointestinal cancers among cannabis users compared to nicotine users.
Authors: Waris Shanawar Ali , Raiker Rahul , Siva Nanda , Boustany Osama , Pakhchanian Haig , Khalid Ahmed A. 
Published: June 2023

10571 Background: Exposure to nicotine is a well-studied preventable cause of numerous malignancies, while the association of cannabis use with the development of cancer is not clear. Cannabis contains both carcinogens as well as compounds with antitumor activity, which inhibit chronic inflammation. The aim of this study is to assess the risk of gastrointestinal malignancy in cannabis users compared to nicotine users. Methods: A retrospective cohort study was conducted using TriNetX, a federated database of ~100 million patient records. Adult patients (≥18 years) were queried by ICD-10 coding to find variables of interest. Two groups were created: one group with a history of only cannabis use and the other with a history of only nicotine use. Then lifetime risk of nine different gastrointestinal cancers were assessed and compared between the two groups. 1:1 propensity score matching was conducted, adjusting for comorbidities and demographics, to calculate adjusted risk ratios (aRR) with 95% Confidence Interval for the comparative analysis. Results: A matched cohort of 413,628 patients revealed that cannabis only patients had a significantly lower lifetime risk of developing esophageal cancer (aRR[95%CI]): (0.456[0.364,0.572]), gastric cancer (0.492[0.41, 0.60]), pancreatic cancer (0.547[0.47,0.64]), liver & intrahepatic bile ducts cancer: (0.728[0.70,0.75]), colon cancer (0.351[0.32,0.38]), rectosigmoid cancer (0.699[0.59,0.83]), and rectal cancer (0.563[0.46,0.68]). No significant differences were seen for small intestinal cancer (1.21[0.88,1.6]) and anal cancer (0.87[0.67,1.14]). Conclusions: The results of this study suggest that the lifetime risk of developing numerous gastrointestinal malignancies is lower in cannabis users when compared to nicotine users. It is not clear if this relative risk reduction is due to the beneficial effects of cannabis or a lack of nicotine consumption and its associated effect on carcinogenesis. Long-term studies following cannabis users may provide a better understanding of the association of cannabis use with the risk of developing various malignancies. Additionally, the quantity of exposure to cannabis and its association with the risk of cancer should be further investigated. [Table: see text]