bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rates of routine cancer screening compared with pre-pandemic levels.
Authors: Oakes Allison H , Boyce Kelly , Patton Catherine , Jain Sanjula , Revol Cindy 
Published: June 2023

10573 Background: The COVID-19 pandemic caused significant disruptions to healthcare delivery in the US due to mandatory stay-at-home orders and patient fears about visiting healthcare facilities. A logical consequence, many forms of healthcare use, including cancer screenings, sharply decreased in early 2020. Early studies suggest that cancer screening rebounded through the summer of 2020; however, > 2 years removed from the start of the pandemic, the long-term impact of missed screenings is unknown. The objective of this study was to examine trends in breast, cervical, and colorectal cancer screening from 2017-2022. Methods: This cross-sectional study used the Trilliant Health national all-payer claims database to analyze calendar year quarterly medical claims from Q1 2017- Q2 2022. We limited the study sample to those aged 21-85, the guideline-concordant target populations for the screening procedures. For breast and cervical cancer, we limited our sample to women. Using Current Procedural Terminology (CPT) codes, we calculated the quarterly number of individuals, per 100,000 eligible beneficiaries, who received screening for breast cancer, cervical cancer, and colorectal cancer. Percentage change in screening tests was compared. Results: In total, the analysis included > 300M unique individuals. For breast cancer, the median quarterly rate of pre-pandemic screening mammography was 8013 per 100k beneficiaries, which declined to 4,884 in Q2 of 2020—a 39% decrease. Screening mammography rebounded to pre-pandemic levels by Q3 and Q4 of 2020 but declined to a median rate of 7,314 per 100,000 beneficiaries in Q2 2022, with quarterly deficits ranging from 4-16%. For cervical cancer, the median quarterly rate of pre-pandemic screening was 5,469 per 100k beneficiaries. The rate of cervical cancer screening fell to 3,550 in Q2 of 2020—a 35% decline. By Q3 2020, cervical cancer screening rebounded toward the pre-pandemic median, then progressively declined to 4,557 per 100k beneficiaries by Q2 2022. Over the same time period, colorectal cancer screening decreased from a pre-pandemic median of 3,111 per 100k beneficiaries to 1,731 in Q2 of 2020—a 44% difference. From Q3 2020 to Q1 2022, the quarterly colorectal cancer screening rate remained 10-17% below pre-pandemic levels, but returned to 3,047 per 100k in Q2 2022, only 2% below the pre-pandemic median. Conclusions: Across the three studied cancer types, population-based screening remains below pre-pandemic levels. In agreement with other research, we find that screening quickly rebounded following the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened. Underutilization of recommended cancer screenings will likely result in an increase in later-stage initial diagnoses and excess mortality from cancer in the future.
Enhancing lung cancer screening through ‘Saved by the Scan’: Lessons from a multipronged public service advertising program.
Authors: Bellur Shreyas S , Ozair Ahmad , Khosla Atulya Aman , Ordonez Kristen , Mileti Papsy , Aguiar Debbie Ferrera , Hernandez Bianca , Pagan Stacy , Cohen Chrissy , Batlle Juan , Dylewski Mark , Ahluwalia Manmeet Singh 
Published: June 2023

10575 Background: Lung cancer screening rates remain low across the US in populations recommended for screening by low-dose CT (LDCT). Screening rates further declined during the COVID-19 pandemic, particularly in high-risk populations including racial and ethnic minorities. The American Lung Association (ALA) launched a nationwide public service advertising (PSA) program called ‘Saved by the Scan’ to enhance lung cancer screening rates, for which Baptist Health South Florida (BHSF) became the first healthcare system partner. The following work describes this major PSA effort in South Florida to enhance lung cancer screening, and the lessons learned thereof. Methods: A multipronged, institutionally-driven public awareness program, in collaboration with ALA, was initiated in 2021 by BHSF, the largest healthcare organization in the region, and was targeted towards South Florida residents. This innovative multimedia effort used traditional communication modalities, including newspapers, billboards, etc., along with digital modalities, including email and social media, to increase lung cancer screening awareness in both English and Spanish in a locally-adapted manner. Key performance indicators (KPIs), reach, and impact of the program were tracked. The most successful components, as per KPIs, were identified. Deidentified data of screening LDCT done at BHSF was reviewed to determine all individuals screened during 2019-2021 and descriptive statistics were calculated. Results: 4619 individuals from South Florida were screened at BHSF from 2019-2021, 1498 were in 2019, 1193 in 2020, and 1928 in 2021. Screening fell by 20.3% in 2020, likely due to the pandemic, and rose by 61.6% in 2021, helped by the program. Overall, a 21.9% increase from pre-COVID screening rates was seen. In 2022, the total reach of traditional media was estimated to be 4,607,273 individuals. Out of 133,554 emails sent, 36,877 (27.2%) were opened, with a click-through rate of 6.4%. Out of 1,768,438 digital impressions, 16,791 (0.9%) had links clicked. The total number of conversions from digital media was estimated to be 337 individuals with 232 (68.9%) from emails and 105 (31.1%) from social media. Conclusions: Lung cancer screening can be successfully boosted through large organizational efforts, particularly those targeted to needs of the local population. Digital media approaches for improving public health have seemingly low conversion rates but their large outreach provides a high impact. Efforts are warranted to enroll more healthcare systems and scale the program nationwide.
Long-term clinical and psychosocial outcomes of surveillance in Li Fraumeni syndrome.
Authors: Zaheed Milita , Napier Christine E , Cops Elisa J , Ferris Nick , Moodie Kate , Milner Brad , Moses Daniel , Poplawski Nicola , Dow Eryn Gaye , Harris Marion , Tucker Kathy , Trainer Alison , James Paul , Thomas David Morgan , Ballinger Mandy L. 
Published: June 2023

10578 Background: Li Fraumeni Syndrome (LFS) is a high penetrance multi-organ cancer predisposition syndrome, associated with a significant lifetime risk of developing cancer. The Surveillance study in Multi-Organ Cancer prone syndromes (SMOC+) is investigating the utility of annual surveillance, with inclusion of whole-body magnetic resonance imaging (WBMRI), for hereditary cancer syndromes without well-established risk management strategies. Here we report the long-term clinical and psychosocial outcome of surveillance in participants with LFS. Methods: Multimodality surveillance in this multi-centre, prospective, longitudinal, observational study for adult participants with LFS included annual clinic review and examination, WBMRI, breast MRI (MRIB), full blood count, prostate specific antigen; 2-5 yearly gastro-intestinal endoscopy and faecal occult blood test in intervening years. Quantitative psychometric evaluations were requested at regular intervals each year using Hospital Anxiety and Depression Scale (HADS), the Impact of Events scale anchored to cancer (IES-C), and the Impact of Events scale MRI (IES-MRI). Results: From July 2013 to December 2021, 132 (67% female) participants were enrolled at a median age of 36 (range 18-69 )years. There were 116 prior diagnoses of neoplasms among 68 (52%) participants, including 27 (20%) with multiple primaries. At a median follow up of 4 years, 46 new primary malignancies were diagnosed in 30 (23%) individuals, with median age at diagnosis of 43 (range 24-71 years). Four (3%) individuals developed recurrence of a prior malignancy. The malignancies were detected as a result of WBMRI (27), MRIB (7), gastroscopy (1), colonoscopy (1) and clinical review and examination (17). The most frequent new primaries were leiomyosarcoma and breast cancer (Table). Overall, 22 (17%) are not currently participating due to cancer related death (10), active cancer (6) or other life events (6). At 4 years after enrollment, 94, 80 and 50 participants completed at least one HADS (463 unique observations), IES-C (362 unique observations), and IES-MRI (268 unique observations) questionnaire, respectively. Controlling for demographic and cancer history variables, there was no evidence of changes in overall anxiety or depression (p=0.2), nor in degrees of distress associated with cancer (p=0.06) or WBMRI (p=0.6) over time. Conclusions: In LFS, annual surveillance with WBMRI is feasible and well tolerated, with no difference in distress experienced in the longer term. Over 80% of participants continue to engage with surveillance. The majority of cancer-affected individuals were able to resume surveillance after management of early disease. [Table: see text]
Does adherence to cancer prevention guidelines before diagnosis associate with improved cancer survival?
Authors: Davis Evan W. , Nair Nisha M. , Hulme Karen , Barone Nancy , Ambrosone Christine B. , Cannioto Rikki A. 
Published: June 2023

10582 Background: The American Institute for Cancer Research and American Cancer Society regularly publish cancer prevention recommendations for decreasing cancer risk. Which lifestyles, or whether they work together to impact cancer survival is not well established. We examined associations of adherence to cancer prevention recommendations with mortality in 5,766 patients enrolled in the Data Bank and BioRepository at Roswell Park. Methods: Patients were newly diagnosed between 2003 and 2016 with a variety of pathologically confirmed invasive malignancies. Detailed epidemiological data including lifestyles one year prior to diagnosis were linked with Tumor Registry data. The primary analytic exposure was a composite Lifestyle Index Score (LIS) created in accordance with previously published standardization guidance; the primary analytic outcome was all-cause mortality. The LIS comprised seven lifestyles including: physical activity (PA); body mass index (BMI); fruit and vegetable (FV) intake; red and processed meat (RPM) intake; sugar sweetened beverage (SSB) consumption; alcohol consumption; and smoking status. Kaplan Meier analyses were used to compare survival experience according to LIS tertiles. Multivariable Cox proportional hazard models adjusted for age, tumor type, stage, and sex were used to estimate the associations of the LIS and each lifestyle factor with mortality in the overall study population and according to tumor stage. Results: During follow-up through April 2022, we observed 2,316 deaths (median follow-up 6.9 years). Patients reporting strongest adherence to prevention recommendations (highest LIS tertile) had significantly improved survival compared to patients with the lowest LIS (93.0 vs. 75.0 months, respectively; log-rank p < 0.0001). In multivariable analyses, the highest versus lowest LIS tertile was associated with a 17% reduction in mortality in the overall study population (HR = 0.83, 95% CI: 0.74-0.93). Significant mortality reductions were observed in patients diagnosed with both early- and late-stage disease (HR = 0.73, 95% CI: 0.59-0.90 and HR = 0.85, 95% CI: 0.73-0.99, respectively). Being a never smoker (HR = 0.54, 95% CI: 0.47-0.62), meeting the PA Guidelines (HR = 0.74, 95% CI: 0.66-0.83), and highest FV intake (HR = 0.82, 95% CI: 0.73-0.91) were the only independent factors associated with significant reductions in mortality. Conclusions: Strongest adherence to the cancer prevention recommendations before diagnosis was associated with significant reductions in mortality. These findings provide additional evidence that modifiable lifestyle factors can impact cancer survival, even among patients diagnosed with advanced-stage disease. Confirmatory studies examining post-diagnosis lifestyles are needed so that lifestyle assessment tools, education, and intervention can be clinically leveraged to improve patient outcomes.
Implementation of universal pan-cancer germline genetic testing in an Arab population: The jordanian exploratory cancer fenetics (Jo-ECAG) study.
Authors: Abdel-Razeq Hikmat , Nielsen Sarah M. , Tbakhi Abdelghani , Bani Hani Hira , Sharaf Baha' , Abu Hijlih Ramiz , Alkyam Mais , Al-Azzam Khansa , Elemian Shatha , Al-Atary Areej , Horani Malek , Zeidan Zeidan , Alzibdeh Abdulla , Russell Emily M. , Heald Brandie , Nussbaum Robert Luke , Esplin Edward D. 
Published: June 2023

10591 Background: Germline genetic testing (GGT) has a significant impact on cancer care. While universal testing has been selectively implemented in the U.S., less is known about adoption of this approach in other ethnic groups. This study reports on GGT results among newly diagnosed cancer patients (pts) in Jordan. Methods: Jo-ECAG was a prospective study of newly diagnosed cancer pts between April 2021 and September 2022 who underwent 84 gene GGT. Patients were classified based on the 2020 National Comprehensive Cancer Network (NCCN) GGT criteria as meeting (in criteria, IC) or not meeting criteria (out of criteria, OOC). Demographics and clinical history were clinician-provided. Pts who were carriers for autosomal recessive conditions were excluded from pathogenic germline variant (PGV) count. Differences in proportions were determined using two-tailed Fisher’s exact test and the significance was set at p≤ 0.05. Results: The cohort consisted of 3,313 Arabic cancer pts, predominantly female (69.8%), with a median age of 54 at testing. Breast was the most commonly diagnosed cancer (50.4%), followed by colorectal (14.9%) and prostate (14.3%). 52% of pts tested were guidelines-based (IC). 460 PGVs were identified in 426 (12.9%) pts. PGVs were most commonly identified in APC (predominantly I1307K variant, 144 pts, 4.4%), BRCA2 (72, 2.2%), BRCA1 (36, 1.1%), CHEK2 (26, 0.8%) and ATM (25, 0.8%). While IC pts were more likely than OOC pts to have a PGV (15.7% vs 9.8%, p<0.0001), 156 (36.6%) pts with PGVs were OOC. 232 (54.5%) pts had PGVs in DNA damage response and repair/homologous recombination repair (DDR/HRR) genes, including 61 (26.3%) OOC pts. 3,602 variants of uncertain significance (VUS) were identified in 2,199 (66.4%) pts with 1,868 of these pts having only VUS results (56.4%), but the frequency in the latter group was not different between IC and OOC pts (p=0.42). Conclusions: Universal GGT of all new cancer pts was successfully implemented and led to actionable findings that would have been missed with guidelines-based testing. With the exception of an overrepresentation of APC I1307K variants, PGV rates were similar to Western ethnic groups. Over half of pts had PGVs in DDR/HRR genes that confer potential eligibility for targeted therapies and/or clinical trials. While VUS rates were high, they were similar between IC and OOC pts. Additional efforts to sequence underrepresented populations and develop variant interpretation methods agnostic to ancestry may help to mitigate these disparities.
Cost-effectiveness analyses of population-based multi-gene testing for the prevention of breast and ovarian cancer in the United States.
Authors: Guo Fangjian , Adekanmbi Victor , Shih Ya-Chen Tina , Berenson Abbey , Kuo Yong-Fang 
Published: June 2023

10596 Background: The current method of testing for BRCA gene mutations, which is based on family history, often fails to identify many carriers. With the advancement of next-generation sequencing technologies, which have significantly lowered the cost of genetic testing and sequencing, population-based testing has been proposed. We evaluated the cost-effectiveness of population-based multi-gene testing as a means of preventing breast and ovarian cancer. Methods: We developed a microsimulation model to assess the cost-effectiveness of multi-gene testing (BRCA1/BRCA2/PALB2) for all women aged 30-35 years compared to the current standard of care that is family history-based. We selected these genes for analyses as they are most prevalent high penetrance genes. We assumed a test uptake rate of 70%. Carriers of pathogenic variants who were not affected by cancer were offered interventions, such as MRI/mammography, chemoprevention, or risk-reducing mastectomy and risk-reducing salpingo-ophorectomy (RRSO), to reduce the risk of breast and ovarian cancer. We incorporated excess coronary heart disease (CHD) deaths from premenopausal RRSO. Our main outcome measure was the incremental cost-effectiveness ratio (ICER)(i.e., cost per-quality-adjusted life year (QALY) gained), with the commonly used societal willingness to pay of $100,000/QALY in the US as the C-E threshold. We ran 500 simulations on 1,000,000 women, employing a lifetime time horizon and payer perspective, and adjusted the cost to 2022 US dollar. We also used probabilistic sensitivity analyses to evaluate model uncertainty. Results: In the base case, population-based multi-gene testing is more cost-effective compared to family-history based testing, with an ICER of $41,306/QALY (95%CI $35,630-$48,441/QALY). This new testing method is able to prevent an additional 1,369 cases of breast cancer and 807 cases of ovarian cancer, but it will also result in 8 excess heart-disease deaths per million women. The probabilistic sensitivity analyses show that the probability that population-based multi-gene testing is cost-effective is 100% for all the simulations. When the cost of the test exceeds $1,100 population-based multi-gene testing becomes economically inefficient (ICER $10,0886/QALY). Conclusions: Population-based multi-gene testing is a more cost-effective option for the prevention of breast cancer and ovarian cancer when compared to current family-history-based testing methods.
Technology-enhanced acceleration of germline evaluation for therapy (TARGET): Results of a randomized controlled trial of a pretest patient-driven webtool vs. genetic counseling for prostate cancer germline testing.
Authors: Giri Veda N. , Keith Scott W. , Cheng Heather H. , Leader Amy , Gross Laura , Sanchez Nolasco Tatiana , Byrne Nataliya , Hartman Rebecca , Brown Lauren , Pieczonka Christopher Michael , Gomella Leonard G. , Kelly William Kevin , Lallas Costas D. , Handley Nathan , Mille Patrick Johnston , Mark James Ryan , Brown Gordon Andrew , Chopra Sameer , McClellan Alexandra , Loeb Stacy 
Published: June 2023

10598 Background: Germline genetic testing is important for prostate cancer management, clinical trial eligibility and hereditary cancer risk assessment. Despite this, genetic testing is underutilized and there is a shortage of genetic counselors. To address these gaps, we designed a webtool to provide patient-driven genetic education and conducted a randomized non-inferiority trial to compare it with traditional pre-test genetic counseling. Methods: TARGET is a multi-center randomized controlled trial comparing standard pre-test genetic counseling versus web-based genetic education (intervention) (NCT04447703). The study protocol was previously published (PMID 35710085). Briefly, patients with prostate cancer who met criteria for germline testing (based on tumor features, ancestry or family history) were randomized to pre-test genetic education through genetic counseling vs a 9-module webtool created by the study team and Prostate Cancer Foundation. The primary endpoint was non-inferiority in reducing decisional conflict between the webtool and genetic counseling by a margin of 4 (set in advance) on the validated Decision Conflict Scale. Analysis of covariance was used to compare decisional conflict between groups. All participants opting for testing received a 51-gene Invitae panel, with results delivered to the patient and their provider. Results: 346 patients with prostate cancer with a mean age of 63.7 years were randomized to genetic counseling (n=174) or web-based genetic education (n=172). Compared to baseline, there were reductions in decisional conflict in both arms following pre-test genetic education (Table). Adjusting for study site and baseline decisional conflict, the test of non-inferiority in reducing decisional conflict between arms was statistically significant (difference = -0.04, 95% CI: -∞ to 1.95, p<0.001). Overall 265 (76.6%) participants underwent genetic testing, including 146 (83.9%) in the genetic counseling and 119 (69.2%) in webtool arm, with the following results: negative (49.4%), variant of uncertain significance (35.5%) and pathogenic variant (15.1%). Conclusions: Delivery of pre-test genetic education through a webtool was non-inferior to genetic counseling in reducing decisional conflict. These results support a new standard of care for the use of patient-driven digital webtools for expanding access to pretest genetic education and informed decision-making for prostate cancer genetic testing. Clinical trial information: NCT04447703 . [Table: see text]
Using patient-reported outcomes to assess the impact of germline genetic testing on prostate cancer patients.
Authors: Nielsen Sarah M. , Shore Neal D. , Gazi Mukaram , Pieczonka Christopher Michael , Heron Sean , Cahn David J , Belkoff Laurence , Berger Aaron D. , Mazzarella Brian , Veys Joseph , Morris David , Bevan-Thomas Richard , Engelman Alexander , Dato Paul , Cornell Robert , Wise David R , Hardwick Mary Kay , Heald Brandie , Nussbaum Robert Luke , Esplin Edward D. 
Published: June 2023

10607 Background: Germline genetic testing (GGT) affords prostate cancer (PCa) patients (pts) opportunities for targeted therapies, prevention and cascade testing. Patient-reported outcomes (PRO) can evaluate physician effectiveness in promoting patient test comprehension and clinical decision making, which are critical to realize the benefits of GGT. PROs from a large PCa GGT study among urologists were analyzed. Methods: A prospective study enrolled unselected PCa pts from 15 primarily community urology practices. Pts underwent 84-gene GGT, with PROs collected via electronic or paper surveys >1-month post GGT. Differences in proportions were determined using two-tailed Fisher’s exact test and significance was set at <0.05. Results: PROs were completed by 561/982 (57%) pts (85% white, 82% non-metastatic, median age at testing 70 years). 59 (11%) pts had positive results, 247 (44%) negative and 255 (46%) variants of uncertain significance (VUS). 72% accurately recalled their result (range, 50% [VUS]-93% [negative]). 66% of positive pts, 80% negative and 54% VUS correctly understood if their result was associated with cancer risk or not. 72% of positive pts had or planned to complete ≥1 physician recommendations, significantly more than negative or VUS pts (Table). Most pts reported that their test result reduced their concerns (40%) or did not impact their level of concern (52%) regarding their PCa diagnosis, treatment or followup. 19% of positive pts reported increased concern. Conclusions: GGT for PCa was deployed without causing undue concern and resulted in adherence to physician recommendations. Still, there is room for improvement in how test results (especially VUS) and recommendations are communicated to pts. [Table: see text]