INTRODUCTION:In 2020, the COVID-19 pandemic led to significant declines in cancer screening, including among women served by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This study examined the spatial association between state-based COVID-19 test percent positivity and proportional change in NBCCEDP screening volume.METHODS:Using the COVID-19 Diagnostic Laboratory Testing dataset, we calculated state-based monthly COVID-19 test percent positivity from July through December 2020 and categorized rates into low, medium, and high groups. We used data from 48 NBCCEDP state awardees to calculate the state-based monthly proportional change in screening volume and compared data for July-December 2020 with the previous 5-year average for those months. We categorized changes in screening volume into large decrease, medium decrease, and minimal change and created maps of the associations between variable subgroups by using bivariate mapping in QGIS.RESULTS:Bivariate relationships between COVID-19 test percent positivity and proportional change in cancer screening volume varied over time and geography. In 5 of 6 months, 4 states had high COVID-19 test percent positivity and minimal change in breast or cervical cancer screening volume; 2 states had high COVID-19 test percent positivity and minimal change in breast and cervical cancer screening volume.CONCLUSION:Some states maintained pre-COVID-19 screening volumes despite high COVID-19 test percent positivity. Follow-up research will be conducted to determine how these states differ from those with consistent decreases in screening volume and identify factors that may have contributed to differences. This information could be useful for planning to maximize NBCCEDP awardees' ability to maintain screening volume during future public health emergencies.

Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.

Introduction Screening can decrease colorectal cancer incidence and mortality and is recommended in clinical practice guidelines. Poor quality of colorectal cancer screening can negate the benefit of screening. The objective of this study was to assess the quality of screening services provided by the Centers for Disease Control and Prevention's Colorectal Cancer Control Program from July 2009 through June 2015. Methods We collected data from the program's 29 grantees, funded to provide colorectal cancer screening and diagnostic services to asymptomatic, low-income, and underinsured or uninsured adults aged 50 to 64. We collected data on the dates and results of all screening and diagnostic tests and, for colonoscopies, on whether the cecum was reached, whether bowel preparation was adequate, and endoscopists' recommendations for the next test. Results Overall, 82.9% (range among grantees, 50.0%-97.2%) of positive FOBTs/FITs were followed up by colonoscopy; 95.2% of colonoscopies occurred within 180 days of the positive stool test. Cecal intubation rates ranged among grantees from 94.2% to 100%. Adenoma detection rates met recommended threshold levels for almost all grantees. Recommendations for rescreening and surveillance intervals deviated from guidelines in both directions. Of clients with normal colonoscopies, 85.3% (range, 37.7%-99.7%) were told to return in 10 years, as recommended in national guidelines. Of clients with advanced adenomas, 55.2% (range, 20.0%-84.6%) were told to return in 3 years as recommended, 25.4% (range, 3.8%-56.6%) in 5 or more years, and 18.6% (range, 0%-47.2%) in less than 3 years. Conclusion Although overall screening quality was good, it varied considerably. Ongoing monitoring to identify performance problems is essential for all colorectal cancer screening activities, so that efforts designed to improve performance can be targeted to individual clinicians.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. This study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group.For the first NBCCEDP-funded mammogram received during 2009-2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication.The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50-64 compared to those aged 40-49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1).Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50-64 years compared to women aged 40-49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50-64 years and providing both screening and diagnostic mammograms.

BACKGROUND Colorectal cancer remains the second leading cause of cancer-related deaths among US men and women. Screening rates have been slow to increase, and disparities in screening remain.METHODS To address the disparity in screening for this high burden but largely preventable disease, the Centers for Disease Control and Prevention (CDC) designed and established a 4-year Colorectal Cancer Screening Demonstration Program (CRCSDP) in 2005 for low-income, under-insured or uninsured men and women aged 50 to 64 years in 5 participating US program sites. In this report, the authors describe the design of the CRCSDP and the overall clinical findings and screening test performance characteristics, including the positive fecal occult blood testing (FOBT) rate; the rates of polyp, adenoma, and cancer detection with FOBTs and colonoscopies; and the positive predicative value for polyps, adenomas, and cancers.RESULTS In total, 5233 individuals at average risk and increased risk were screened for colorectal cancer across all 5 sites, including 44% who underwent screening FOBT and 56% who underwent screening colonoscopy. Overall, 77% of all individuals screened were women. The FOBT positivity rate was 10%. Results from all screening or diagnostic colonoscopies indicated that 75% had negative results and required a repeat screening colonoscopy in 10 years, 16% had low-risk adenomas and required surveillance colonoscopy in 5 to 10 years, 8% had high-risk adenomas and required surveillance colonoscopy in 3 years, and 0.6% had invasive cancers.CONCLUSIONS This report documents the successes and challenges in implementing the CDC's CRCSDP and describes the clinical outcomes of this 4-year initiative, the patterns in program uptake and test choice, and the comparative test performance characteristics of FOBT versus colonoscopy. Patterns in final outcomes from the follow-up of positive screening tests were consistent with national registry data. Cancer 2013;119(15 suppl):2820-33. (c) 2013 American Cancer Society.The Centers for Disease Control and Prevention designed and established a 4-year Colorectal Cancer Screening Demonstration Program (CRCSDP) in 2005 for low-income, under-insured or uninsured men and women aged 50 to 64 years in 5 participating US program sites. This report documents the successful implementation of the CRCSDP and describes the clinical outcomes of this 4-year initiative, patterns in program uptake and test choice, challenges in implementation of fecal occult blood test screening programs, and comparative test performance characteristics of fecal occult blood testing versus colonoscopy.

OBJECTIVES:To determine the effects of program policy changes, we examined service delivery benchmarks for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).METHODS:We analyzed NBCCEDP data for women with abnormal mammogram or clinical breast examination (n=382 416) from which 23 701 cancers were diagnosed. We examined time to diagnosis and treatment for 2 time periods: 1996 to 2000 and 2001 to 2005. We compared median time for diagnostic, treatment initiation, and total intervals with the Kruskal-Wallis test. We calculated adjusted proportions (predicted marginals) with logistic regression to examine diagnosis and treatment within program benchmarks (<or=60 days) and time from screening to treatment (<or=120 days).RESULTS:Median diagnostic intervals decreased by 2 days (25 vs 23; P<.001). Median treatment initiation intervals increased by 2 days (12 vs 14; P<.001). Total intervals decreased by 3 days (43 vs 40; P<.001). Women meeting the 60-day benchmark for diagnosis improved the most for women with normal mammograms and abnormal clinical breast examinations from 77% to 82%.CONCLUSIONS:Women screened by the NBCCEDP received diagnostic follow-up and initiated treatment within preestablished program guidelines.

Purpose: Cytokines, aberrantly produced by cancer cells, have recently been implicated in the severity of cancer-related pain. We hypothesize that functional variations in cytokine genes could explain the variability in cancer-related pain. Methods: Pain, clinical and demographic variables were assessed at presentation and prior to initiating any cancer treatment in 514 patients with non–small cell lung cancer. Using the TaqMan method, we genotyped single nucleotide polymorphisms in interleukin (IL)-6 ( (cid:1) 174GC), IL-8 ( (cid:1) 251TA), and tumor necrosis factor- a (TNF- a ; (cid:1) 308 GA), and determined their associations with pain severity in newly diagnosed early and advanced stage lung cancer. Results: White Caucasians with early ( n = 252) and advanced stage ( n = 262) non–small cell lung cancer comprised the sample. Pain severity predictably varied by stage of disease, sex, depressed mood, age, and genotype groups. Linear regression analyses showed TNF- (cid:1) 308GA (coeff = 0.16; P = 0.008); sex (coeff = 0.19; P = 0.001), and age (coeff = (cid:1) 0.16; P = 0.002) as significant predictors for pain severity in early stage lung cancer. Among those with advanced stage lung cancer, we observed statistical- ly significant main effects for IL-8 (cid:1) 251 TA (coeff = 0.221; P < 0.001) and significant joint effects of IL-8 (cid:1) 251 TA and age (coeff = (cid:1) 0.0256; P < 0.001) and TNF- (cid:1) Purpose: We hypothesize that a lower cancer incidence among Amish adults is possibly due to diet and lifestyle factors. This study examines the physical activity (PA) levels between Amish and non-Amish adults living in Ohio Appalachia. Methods: Amish ( n = 134) and non-Amish ( n = 154) adults completed interviews as part of a lifestyle study. Self-report of PA level was measured by the International Physical ActivityQuestionnaire(IPAQ)andbyadiaryofstepsperday(pedometer:Digi-WalkerSW-200).Totalmetabolicequiv-alenttasksminuteswerecalculatedfromtheIPAQandaveragenumberofstepsperdayfromthepedometerdiary. Results: The Amish men walked more steps per day (11,447 + 611 versus 7,605 + 643; P < 0.001) and had a higher IPAQ score(metabolicequivalenttasksmin/wk;8,354+701versus5,547+690; P = 0.006) than non-Amish men. In addition, Amish farmers walked more steps per day than Amish non-farmers (15,278 + 1,297 versus 10,742 + 671; P = 0.0026). Amish women walked more steps per day (7,750 + 477 versus 6,547 + 437; P = 0.066) and had higher IPAQ scores (4,966 + 503 versus 3,702 + 450; P = 0.064) compared with non-Amish women. Conclusions: Two measures of PA showed a higher PA level among Amish men, especially farmers, and a trend for higher PA level among Amish women. Higher levels of PA warrants further investigation as one factor contributing to reduced cancer incidence rates among the Amish. an Advantage Over Either Full-Field Digital Mammography Screen-Film Purpose: To compare the cancer detection rate and receiver operating characteristics (ROC) area under the curve of full-field digital mammography, screen-film mammography, and a combined technique that allowed diagnosis if a finding was suspicious on film, on digital, or on both. Methods: We used the data originally analyzed in Lewin et al.’s trial, in which 6,736 paired full-field and digital mammograms were done in 4,489 women. We used parametric and nonparametric tests to compare the area under the curve for ROC scores of film-screen only, digital mammography only, and the combined test. We used McNemar’s test for paired proportions to compare the cancer detection rates. Results: With the parametric test, neither the difference in the area under the curve between the film and combined, nor the difference between the digital and combined ROC curves was significant at the Bonferroni-corrected 0.025 a level (film versus combined difference = 0.06, P = 0.07; digital versus combined difference = 0.09, P = 0.05). The nonparametric test showed that there was a significant difference between both film and combined (difference = 0.07, P = 0.01) and digital versus combined ROC curves (difference = 0.12, P = 0.001). The continuity-corrected McNemar’s test showed a significant increase in the proportion of cancers detected by the combined modality over film mammography ( m 2 = 7.1, df = 1, P = 0.01), and over digital mammography ( m 2 = 12.07, df = 1, P = 0.001). promote multiple behavior changes for CRC prevention. A telephone survey was given at baseline and 12 months. Recreational physical activity (RPA) was calcu-lated as metabolic equivalent task hours per week. The CRC screening outcome was test completion (fecal occult blood test, flexible sigmoidoscopy, double contrast barium enema, or colonoscopy) within the past year and was limited to participants ages 50 and older. Analyses controlled for baseline levels of screening/RPA, age, education, gender, and church cluster. Results: Analyses revealed a significant interaction effect ( P = 0.02) of weight group and intervention condition on RPA metabolic equivalent tasks at follow-up, but not for weight or condition alone. Normal and overweight individuals receiving the lay health advisor intervention increased RPA more, whereas obese I and II responded more to the tailored print and video intervention. For CRC screening, the interaction was not significant; only weight remained related to past year of screening at follow-up ( n = 266, P = 0.08), with obese individuals reporting fewer CRC screenings. Conclusion: Results suggest that, at least for physical activity, interventions may be differentially effective based on obesity status. Targeting and tailoring of cancer prevention interventions based on weight may be a promising strategy for reaching out to risk groups. (SIR (SIR of SIRs of the proband. the a genetic for cancer in We a 2-fold increase brain a 22% increase in expected cases of all cancers the FDRs of glioma probands. The brain and an increase in not been previously reported. We also found a borderline increase in pancreatic cancer, due to p16 mutations among these families. Purpose: To examine the intervals between breast cancer screening, diagnosis, and treatment initiation among low-income and uninsured women screened in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) during two time periods. Methods: We examined diagnostic and treatment intervals for the time periods 1996 to 2000 and 2001 to 2005. The intervals were defined as: ( a ) time between mammography and final diagnosis for all women receiving an abnormal mammogram result (including suspicious abnormality, highly suspicious for malignancy, and assessment is incomplete) or abnormal clinical breast exam result and; ( b ) time between diagnosis and treatment initiation among those diagnosed with cancer. Results: For the study period, 369,557 women screened for breast cancer through the NBCCEDP had abnormal screen results. For 1995 to 2000 and 2001 to 2005, the median interval to diagnosis after screening was 25 and 23 days, respectively. For 22,302 women found to have cancer, the median interval from diagnosis to treatment increased from 12 to 14 days in the later time period. Overall, time to diagnosis improved in 2001 to 2005 compared with 1995 to 2000. In the second time period, 92% of women were treated within 120 days. Summary: The goal of the NBCCEDP is to assure that women receive quality breast cancer screening and diagnostic services, and initiate treatment. Our data show that the program is meeting this goal. Disparities in breast cancer outcomes should diminish once all women have timely work-up and treatment of breast problems. Purpose: To examine the relationship between cognitive sus- ceptibility to smoking and well-known risk factors for smoking initiation among 11- to 13-year-olds of Mexican origin. Methods: Participants in this study were drawn from an infrastructure of population-based households created by the Department of Epidemiology at M.D. Anderson Cancer Center.Householdswithage-eligibleparticipantswereiden-tifiedfromthecohortdatabase;>90%ofallparentswhowerecontactedagreedtoenrolltheirchildinthestudy.Afterobtaininginformedconsent,surveydatawerecollectedonsmokingsusceptibilityandsmokingstatus,acculturation,demographics,peerandfamilyinfluences,schoolandneigh-borhoodcharacteristics,andattitudestowardssmoking. Results: Bivariate associations between susceptibility and risk factors were predominantly significant and in the expected direction. Significant predictors were included in stepwise and additive effects logistic regression models. The stepwise model revealed that each additional positive smoking expectation was associated with a 5-fold increased chance of being susceptible. Susceptibles were more likely to report that most friends smoke, have a mother who smokes, believe that peer norms strongly support smoking, were 13 years old, male, perceived more temptations to smoke, have more acculturated parents, and report lower subjective social status than their nonsusceptible peers. The additive effects model noted increasing risk of susceptibility with increasing number of risk factors ( P trend < 0.01). Participants reporting three risk factors were 2.58 times and those with six or more risk factors were 22.12 times more likely to be susceptible to smoking, compared with participants reporting one or no risk factors. Summary: Our findings suggest a need to develop both family- and school-based primary prevention programs.

INTRODUCTION:Integrating one or more public health programs may improve the ability of programs to achieve common goals. Expanding knowledge on how program integration occurs, how it benefits each individual program, and how it contributes to the achievement of common goals is an important area of inquiry in public health.METHODS:The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program combined data from 10 of their overlapping state or tribal programs to calculate prevalence estimates of repeat mammography at 18 months. The data were stratified by whether women attended the combined program or only the NBCCEDP. Logistic regression analyses were conducted to identify factors that were thought to independently contribute to a greater likelihood of a woman receiving a repeat mammogram.RESULTS:Women who participated in both programs were 1.5 to 5.1 times as likely to be rescreened, depending on program location, as women who participated only in the NBCCEDP. WISEWOMAN participants who received a follow-up WISEWOMAN screening for chronic disease risk factors within a year of their initial WISEWOMAN screening were 5 times more likely to return for a follow-up mammogram through the NBCCEDP than were WISEWOMAN participants who did not.DISCUSSION:Participation in both the NBCCEDP and the WISEWOMAN program is associated with a greater likelihood of a woman returning for a follow-up mammogram within 18 months of her initial examination. Collecting more in-depth information on motivational factors and on the association between receipt of multiple services and a woman's engagement in a health program should be the subject of future research.

OBJECTIVES To examine time intervals from cervical cancer screening to diagnosis and treatment initiation among low-income and uninsured women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) during two consecutive time periods. METHODS We analyzed NBCCEDP data for women with abnormal Pap tests (n=100,167), from which 1,417 invasive cervical cancers were diagnosed. We examined two time intervals for this study: diagnostic interval (time from abnormal Pap test to the date of definitive diagnosis) and treatment initiation interval (time from definitive diagnosis to treatment initiation) for two time periods: 1996-2002 and 2003-2009. We compared median time intervals for diagnostic and treatment initiation using the Kruskal-Wallis test. Adjusted proportions (predicted marginals) were calculated using logistic regression to examine diagnosis and treatment within program benchmarks (≤60 days). RESULTS Median diagnostic intervals decreased overall by 6 days (54 vs. 48 days, p<0.001). This decrease in the median diagnostic interval was noted for all variables examined. The median treatment initiation intervals remained stable over the two time periods. CONCLUSIONS Women screened by the NBCCEDP receive diagnostic follow-up and initiate treatment within preestablished program guidelines.