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Zhang X, Elsaid MI, DeGraffinreid C, Champion VL, Paskett ED. Impact of the COVID-19 Pandemic on Cancer Screening Delays. J Clin Oncol 2023; 41:3194-3202. [PMID: 36735899 PMCID: PMC10256430 DOI: 10.1200/jco.22.01704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/29/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To examine delays in cancer screenings during the COVID-19 pandemic. METHODS Participants from previous studies (N = 32,989) with permissions to be recontacted were invited to complete a survey between June and November 2020. Participants (n = 7,115) who met the age range for cancer screenings were included. Participants were asked if they planned to have and then if they postponed a scheduled mammogram, Pap test, stool blood test, colonoscopy, or human papillomavirus (HPV) test. Logistic regression was used to determine the factors associated with cancer screening delays for each planned test. RESULTS The average age was 57.3 years, 75% were female, 89% were non-Hispanic White, 14% had public insurance, and 34% lived in rural counties. Those who planned cancer screenings (n = 4,266, 60%) were younger, more likely to be female, with higher education, had private insurance, and lived in rural counties. Specifically, 24% delayed a mammogram (n = 732/2,986), 27% delayed a Pap test (n = 448/1,651), 27% delayed an HPV test (n = 59/220), 11% delayed a stool blood test (n = 44/388), and 36% delayed a colonoscopy (n = 304/840). Age, race/ethnicity, education, and health insurance were associated with delays in cancer screenings (all P < .05). Compared with non-Hispanic White women, non-Hispanic Black women had lower odds of delaying a mammogram (odds ratio [OR], 0.60; 95% CI, 0.39 to 0.94), Hispanic women had higher odds of delaying Pap test (OR, 2.46; 95% CI, 1.34 to 4.55), and women with other race/ethnicity had higher odds of delaying both Pap test (OR, 2.38; 95% CI, 1.41 to 4.02) and HPV test (OR, 5.37; 95% CI, 1.44 to 19.97). CONCLUSION Our findings highlighted the urgency for health care providers to address the significant delays in cancer screenings in those most likely to delay. Strategies and resources are needed to help those with barriers to receiving guideline-appropriate cancer screening.
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Affiliation(s)
- Xiaochen Zhang
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mohamed I. Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Cecilia DeGraffinreid
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Victoria L. Champion
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Dhanasekara CS, Khan H, Rahman RL. Impact of Access to Breast Care For West Texas Program on Early Detection and Regional Breast Cancer Mortality. Cancer Control 2023; 30:10732748231167254. [PMID: 37158405 PMCID: PMC10176556 DOI: 10.1177/10732748231167254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION This study aimed to assess whether the Access to Breast Care for West Texas (ABC4WT) program impacted regional breast cancer detection and mortality in the Texas Council of Governments (COG)1 region. METHODS Interrupted time series analyses were utilized to evaluate the impact of the intervention. Spearman's rank correlation and cross-orrelation analyses were performed to assess the relationship between the total number of screenings and (i) the total number of breast cancer detected and (ii) the proportion of early-stage cancer detected and the (pre-whitened) residuals. A three-way interaction model compared pre-and post-intervention mortality in COG 1 with the COG 9 region (control). RESULTS Increased screening rate was associated with increased breast and early-stage cancer incidences (P = .001 and P = .002, respectively). There were significant positive cross-correlations between the total number of screenings and the total number of breast cancer detected (r = .996) and the proportion of early-stage cancer detected (r = .709) without a lag even after pre-whitening. Univariate analysis showed that regional mortality decreased with time (P < .001) and after intervention (P = .001). Multivariate analysis did not show any significant difference in time (P = .594), intervention (P = .453), and time and intervention interaction (P = .273). The three-way interaction model showed no difference in the baseline mortality and pre-intervention trend difference in COG 1 and COG 9 regions. However, there was a significant pre-post intervention trend difference in mortality COG 1 compared to the COG 9 region (P = .041). CONCLUSION Implementing the ABC4WT program was associated with the early detection of breast cancer and reducing regional mortality in the COG 1 region.
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Affiliation(s)
| | - Hafiz Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rakhshanda L Rahman
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Singh D, Singh AK, Tiwari S. Breast Thermography as an Adjunct Tool to Monitor the Chemotherapy Response in a Triple Negative BIRADS V Cancer Patient: A Case Study. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:737-745. [PMID: 34694994 DOI: 10.1109/tmi.2021.3122565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Prior studies have reported that breast thermography is a potential adjunct tool to mammography in early cancer detection, especially in developing countries with limited medical facilities. This non-invasive, safe, and painless screening tool can reduce the mortality due to cancer by early detection and monitoring. This prospective study aims to analyze changes in static breast thermograms of a BIRADS V category breast cancer patient to assess the response to Neoadjuvant chemotherapy (NACT) in locally advanced cancer and to compare with thermograms of a BIRADS II category benign patient. Breast thermograms of the malignant and benign patients in five different views were taken using FLIR E40 thermal camera under strict acquisition protocols. Details of the patient along with the thermograms were recorded pre and post NACT. There is a qualitative reduction in the warm region of the surface after the first cycle of chemotherapy treatment. Thermal, fractal, and statistical analysis of thermograms is performed for both patients. In the patient with aggressive ductal carcinoma, the difference in the mean surface temperature between contralateral breasts is high, which is reduced after the first cycle of NACT. This preliminary study indicates that breast thermography can potentially be used as an effective non-invasive, non-contact, and radiation-free tool to analyze the effect of NACT on patients with different stages of breast cancer. This study also signifies the role of the thermography technique in reaching a largely rural population with limited medical resources for early cancer screening.
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van den Bruele AB, Sevilimedu V, Jochelson M, Formenti S, Norton L, Sacchini V. Mobile mammography in New York City: analysis of 32,350 women utilizing a screening mammogram program. NPJ Breast Cancer 2022; 8:14. [PMID: 35064104 PMCID: PMC8782895 DOI: 10.1038/s41523-022-00381-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
Mobile mammography vans (mammovans) may help close the gap to access of breast cancer screening by providing resources to underserved communities. Minimal data exists on the populations served, the ability of mammovans to reach underserved populations, and the outcomes of participants. We sought to determine the demographic characteristics, number of breast cancers diagnosed, and number of women who used the American Italian Cancer Foundation (AICF) Mobile, No-Cost Breast Cancer Screening Program within the five boroughs of New York City. Data were collected by the AICF from 2014 to 2019 on a voluntary basis from participants at each screening location. Women aged 40 to 79 years who had not had a mammogram in the previous 12 months were invited to participate. Each participant underwent a clinical breast exam by a nurse practitioner followed by a screening mammogram. Images were read by a board-certified radiologist contracted by the AICF from Multi Diagnostic Services. There were 32,350 participants in this study. Sixty-three percent reported an annual household income ≤$25,000, and 30% did not have health insurance. More than half of participants identified as either African American (28%) or Hispanic (27%). Additional testing was performed for 5359 women found to have abnormal results on screening. In total, 68 cases of breast cancer were detected. Breast cancer disparities are multifactorial, with the greatest factor being limited access to care. Mobile, no-cost mammogram screening programs show great promise in helping to close the gap to screening access.
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Affiliation(s)
| | - Varadan Sevilimedu
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxine Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Larry Norton
- Breast Medicine, Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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LeBlanc G, Lee I, Carretta H, Luo Y, Sinha D, Rust G. Rural-Urban Differences in Breast Cancer Stage at Diagnosis. WOMEN'S HEALTH REPORTS 2022; 3:207-214. [PMID: 35262058 PMCID: PMC8896172 DOI: 10.1089/whr.2021.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/13/2022]
Abstract
Purpose: To analyze the extent to which rural-urban differences in breast cancer stage at diagnosis are explained by factors including age, race, tumor grade, receptor status, and insurance status. Methods: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 database, analysis was performed using data from women aged 50–74 diagnosed with breast cancer between the years 2013 and 2016. Patient rurality of residence was coded according to SEER's Rural-Urban Continuum Code 2013: Large Urban (RUCC 1), Small Urban (RUCC 2,3), and Rural (RUCC 4,5,6,7,8,9). Stage at diagnosis was coded according to SEER's Combined Summary Stage 2000 (2004+) criteria: Localized (0,1), Regional (2,3,4,5), and Distant (7). Descriptive statistics were analyzed, and variations were tested for across rural-urban categories using Kruskall–Wallis and Kendall's tau-b tests. Additionally, odds ratios (ORs) and 95% confidence intervals for the three ordinal levels of rural-urban residence were calculated while adjusting for other independent variables using ordinal logistic regression. Results: The rural residence category showed the largest proportion of women diagnosed with distant stage breast cancer. Additionally, we determined that patients with residence in both large and small urban areas had statistically significantly lower odds of higher stage diagnosis compared to rural patients even after controlling for age, race, tumor grade, receptor status, and insurance status. Conclusions: Rural women with breast cancer show small but statistically significant disparities in stage-at-diagnosis. Further research is needed to understand local area variation in these disparities across a wide range of rural communities, and to identify the most effective interventions to eliminate these disparities.
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Affiliation(s)
- Gabrielle LeBlanc
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Inkoo Lee
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | - Henry Carretta
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Yi Luo
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Debajyoti Sinha
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | - George Rust
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
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Shete S, Deng Y, Shannon J, Faseru B, Middleton D, Iachan R, Bernardo B, Balkrishnan R, Kim SJ, Huang B, Millar MM, Fuemmler B, Jensen JD, Mendoza JA, Hu J, Lazovich D, Robertson L, Demark-Wahnefried W, Paskett ED. Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States. JAMA Netw Open 2021; 4:e2128000. [PMID: 34605915 PMCID: PMC8491105 DOI: 10.1001/jamanetworkopen.2021.28000] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. Objectives To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. Design, Setting, and Participants This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. Main Outcomes and Measures Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. Results The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. Conclusions and Relevance In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.
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Affiliation(s)
- Sanjay Shete
- Division of Cancer Prevention, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Jackilen Shannon
- Oregon Health & Sciences University, Portland State University School of Public Health, Portland
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City
| | | | | | - Brittany Bernardo
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus
| | | | - Sunny Jung Kim
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | - Bin Huang
- Department of Cancer Biostatistics, University of Kentucky, Lexington
| | | | - Bernard Fuemmler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | | | - Jason A. Mendoza
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City
| | - DeAnn Lazovich
- University of Minnesota School of Public Health, Minneapolis
| | - Linda Robertson
- UPMC Hillman Cancer Center, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, College of Medicine, Columbus
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Stahr S, Chiang T, Bauer MA, Runnells GA, Rogers LJ, Vi Do H, Kadlubar SA, Joseph Su L. Low‑Level Environmental Heavy Metals are Associated with Obesity Among Postmenopausal Women in a Southern State. EXPOSURE AND HEALTH 2021; 13:269-280. [PMID: 34337191 PMCID: PMC8323941 DOI: 10.1007/s12403-020-00381-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Both arsenic and cadmium are reported to be toxic to humans. The use of saliva as a biomarker of low-level exposures to these elements has not been adequately explored, and the putative relationship between exposure and obesity is unclear. This cross-sectional study aims to investigate the relationship between salivary arsenic and cadmium concentrations and their association with obesity. Arsenic and cadmium concentrations were analyzed in human saliva samples by Inductively Coupled Plasma-Mass Spectrometry on 270 randomly selected women who participated in the Arkansas Rural Community Health Study. Multivariable logistic regression was performed to evaluate the association between heavy metal concentrations and obesity. Stratified logistic regression was performed based on menopausal status. Generalized linear models were used to evaluate weight gain velocity. Significant positive associations were observed in postmenopausal women for both arsenic (OR = 4.43, 95% CI 1.91-10.28) and cadmium (OR = 2.72, 95% CI 1.23-5.99) concentrations, as well as significant trends among tertiles (p < 0.01 and p = 0.01, respectively). No relationship with obesity was evident among premenopausal women for either metal. A dose-response relationship was observed between increasing weight gain velocity and increasing metal concentrations. At concentrations well below governmental and industrial standards for acute toxicity, significant associations between obesity and concentration of these heavy metals are evident. The rate at which individuals gain weight is affected by metal concentrations and may play a role in the rapid increase in weight in postmenopausal women. These results might explain, in part, the missing variability in the increasing obesity pandemic in certain population exposed to these environmental toxicants.
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Affiliation(s)
- Shelbie Stahr
- Interdisciplinary Biomedical Sciences, Department of Clinical and Translational Sciences, University of Arkansas Medical Sciences, 4301 W. Markham St. Slot #601, Little Rock, AR 72205, USA
| | - Tung‑chin Chiang
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas Medical Sciences, 4301 West Markham, # 820, Little Rock, AR 72205, USA
| | - Michael A. Bauer
- Department of Biomedical Informatics, College of Medicine, University of Arkansas Medical Sciences, 4018 W Capitol Ave, Little Rock, AR 72205, USA
| | - Gail A. Runnells
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas Medical Sciences, 4301 W. Markham St. # 820, Little Rock, AR 72205, USA
| | - Lora J. Rogers
- COPH Department of Epidemiology Slot 721-21, Winthrop P. Rockefeller Cancer Institute, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4104 Outpatient Circle, Little Rock, AR 72205-7101, USA
| | - Huyen Vi Do
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas Medical Sciences, 4301 W. Markham St. # 820, Little Rock, AR 72205, USA
| | - Susan A. Kadlubar
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas Medical Sciences, 4301 West Markham, # 820, Little Rock, AR 72205, USA
| | - L. Joseph Su
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas Medical Sciences, 4301 W. Markham St. # 820, Little Rock, AR 72205, USA
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