Importance:Significant incidental findings (SIFs) not related to lung cancer have been widely reported in patients undergoing lung cancer screening with low-dose computed tomography (LDCT). It is unclear whether SIFs are associated with extrapulmonary cancer diagnoses. Objective:To examine the association between an SIF considered to be potentially indicative of extrapulmonary cancer (cancer SIF) detected at LDCT lung cancer screening and diagnosis of an extrapulmonary cancer within 1 year of the screen. Design, Setting, and Participants:This retrospective cohort study analyzed data from National Lung Screening Trial (NLST) participants. The NLST participants were randomly assigned to either LDCT or chest radiography to determine whether LDCT was associated with a reduction in lung cancer mortality compared with chest radiography alone. Participants aged 55 to 74 years were recruited between August 2002 and April 2004. They received up to 3 rounds of screening and were followed up for 5 to 7 years. The study concluded December 31, 2009. This analysis was restricted to participants in the LDCT arm and was conducted between June and December 2025. Exposure:Detection of a cancer SIF (ie, SIF potentially indicative of a cancer) at any lung cancer screening round in the NLST. Main Outcomes and Measures:The primary outcome was diagnosis of an extrapulmonary cancer within 1 year of a screening round. Extrapulmonary cancers were classified using Surveillance, Epidemiology, and End Results (SEER) Program organ system categories. Cancer SIFs were mapped to specific SEER cancer categories. Multilevel logistic regression was used to assess the association between detection of a cancer SIF and diagnosis of an extrapulmonary cancer. Results:The study included 75 104 LDCT screening rounds performed in 26 445 participants (mean [SD] age, 61.4 [5.0] years; 59.0% male). Cancer SIFs were reported for 2265 screening rounds (3.0%) in 1807 participants (6.8%) across the 3 screening rounds. An extrapulmonary cancer was diagnosed following a screening round with a cancer SIF (n = 2265) for 67 participants (3.0%). The marginal risk difference, after covariates and participant-specific adjustments, was 13.89 (95% confidence limit [CL], 7.03-20.75) per 1000 participants. The marginal risk differences were significantly higher for urinary cancers (17.03 [95% CL, 8.55-25.50] per 1000 participants) and other SEER cancer categories, including lymphoma and leukemia (13.83 [95% CL, 3.46-24.21] per 1000 participants). Conclusions and Relevance:This cohort study found that cancer SIFs were associated with an increased risk of an extrapulmonary cancer diagnosis in the year following an LDCT lung cancer screening examination. These findings suggest that certain SIFs should be evaluated as potential indicators of undiagnosed cancers.

Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality in the United States, with rates recently increasing among adults younger than 65 years. In 2018, the American Cancer Society (ACS) lowered the recommended age to initiate screening for average-risk adults to age 45 years. Since then, new molecular-based screening tests-a multitarget stool RNA test (mt-sRNA), a next-generation mt-sDNA test, and a blood-based cell-free DNA assay-have received regulatory approval for CRC screening. For this update, the ACS Guideline Development Group commissioned a targeted, systematic evidence review evaluating diagnostic performance and published modeling studies to judge the potential impact of these tests on CRC incidence and mortality. The ACS reaffirms the recommendation that average-risk adults should initiate CRC screening at age 45 years and continue through age 75 years for those with a life expectancy greater than 10 years. Consistent with prior guidelines, the ACS emphasizes that offering multiple, recommended screening options supports informed patient choice and may improve participation, because the most effective screening test is the one that the patient completes. The next-generation mt-sDNA test, which is an updated version of an already recommended mt-sDNA test, and the mt-sRNA test demonstrated high sensitivity for CRC and moderate sensitivity for advanced precancerous lesions and are recommended, along with annual high-sensitivity fecal immunochemical and high-sensitivity guaiac-based fecal occult blood tests, as preferred stool-based screening options at 3-year intervals. Compared with established stool-based tests, blood-based tests demonstrated lower sensitivity for both advanced precancerous lesions and stage I cancers, with modeling studies predicting less effectiveness in reducing CRC incidence and mortality. At this time, blood-based tests should be recommended only to individuals who decline or do not complete preferred screening tests. Ongoing evaluation of adherence, real-world implementation, and clinical outcomes will inform future updates for these new tests. For screening to be effective, a positive result on any noncolonoscopy screening test requires timely follow-up with colonoscopy, preferably within 6 months, to complete the screening process.

Lung cancer screening (LCS) with low-dose computed tomography has the potential to improve early detection and promote more equitable health outcomes. However, traditional eligibility criteria, based primarily on age and smoking history, may overlook high-risk individuals, particularly in underrepresented populations. These include racial minorities and individuals living in rural areas, who often face limited access to screening centers and high-quality imaging interpretations. Artificial intelligence (AI) offers promising solutions to potentially enhance the effectiveness and equity of LCS. First, AI could refine risk stratification by incorporating additional clinical data, social determinants of health, environmental exposures, and comorbidities, thereby identifying high-risk individuals who may be missed by conventional criteria (e.g., Black Americans, women). Second, AI could improve access to high-quality screening by enhancing image acquisition across diverse technologies and enabling remote interpretation through telehealth. Third, AI tools could support radiologists by increasing the accuracy of nodule detection and improving the assessment of malignancy risk in detected nodules. Finally, AI could assist in managing incidental findings and facilitate opportunistic screening, further expanding the impact of LCS. Despite its promise, the implementation of AI in clinical practice faces several barriers. These include regulatory hurdles, the need for clinical billing codes, and substantial investment in infrastructure, training and ongoing monitoring of these technologies. Further, the consideration of fairness-aware frameworks to mitigate racial bias in AI tools developed from non-representative datasets. Integrating AI into the radiologic workflow, with attention to these challenges, may address disparities and improve the overall quality and reach of LCS. However, AI implementation will need to be carefully evaluated to determine whether it is achieving these goals.

INTRODUCTION:US guidelines recommend surveillance colonoscopy after polyp removal, but stool testing may offer a more efficient, acceptable strategy for patients with nonadvanced lesions. We conducted exploratory analyses to evaluate the diagnostic accuracy of quantitative fecal immunochemical testing (FIT) results to diagnose advanced colorectal neoplasia in patients undergoing surveillance colonoscopy. METHODS:We classified patients by previous colonoscopy findings as having low, intermediate, or high risk polyps. We compared the diagnostic performance for detecting advanced colorectal neoplasia at an optimal cutoff identified by the Youden index vs the standard cutoff of 100 ng/mL. We also estimated cumulative sensitivity and specificity for serial FIT testing in patients with nonadvanced findings. RESULTS:Among the 449 participants (mean ± SD age 65.4 ± 7.1, 53.2% women, and 92.7% White), the median interval between colonoscopies was 5.0 years (IQR 3.5, 5.6); adequate or better bowel prep was achieved in 89.3%, and cecal intubation in 98.4%. We detected 55 advanced precancerous lesions, but no cancers. For patients with previous nonadvanced lesions (n = 378), the optimal cutoff was 26 ng/mL. Compared with the standard cutoff, the optimal cutoff increased sensitivity (14.3%-35.7%, P < 0.01) but reduced specificity (95.5%-79.2%, P < 0.01). Estimated cumulative sensitivity across 3 rounds of FIT testing was 73.4% at the optimal cutoff vs 37.1% with the standard cutoff. DISCUSSION:Lowering the FIT hemoglobin cutoff markedly improved sensitivity for detecting advanced precancerous lesions in patients without previous advanced polyps. Serial testing could further enhance detection. FIT-based surveillance should be further evaluated as a potential strategy to prioritize, delay, or replace colonoscopy.

Introduction Measuring DNA methylation levels at cg05575921 can improve prediction of lung cancer (LC) risk in a screening eligible population. However, these findings were based on a limited number of largely White study participants, with a history of heavy smoking (>30 pack years [PY]) and the cg05575921 based-metric was not directly compared to existing standards for LC prediction.] Method We determined cg05575921 methylation levels in a nested case and control cohort featuring 1156 LC cases and 3039 controls, matched for age, sex, race and self-reported smoking status (current and former), who participated in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. We then constructed survival algorithms that tested whether adding cg05575921 methylation levels to a model consisting of PLCOm2012and PY improved the prediction of time to lung cancer diagnosis as compared to the PLCOm2012algorithm. Results Models adding cg05575921 methylation levels to PLCOm2012and PY significantly improved prediction of LC occurrence over 20-year follow up for subjects who report current or former smoking. In this set of subjects matched for age, sex and smoking status, a simple algorithm using cg05575921 and PY outperformed the PLCOm2012in all smokers (20-yr area under the curve [AUC] 0.725 vs 0.689), ≥ 20 PY smokers (20-yr AUC 0.662 vs 0.634) and < 20 PY smokers (20-yr AUC 0.666 vs 0.549). Among participants with < 20 PY smoking histories, those with cg05575921 methylation levels < 80% were at 3.3-fold greater risk for LC than those with similar PY history but with cg05575921 methylation levels > 80%. Conclusion The use of cg05575921 methylation levels can improve the accuracy of LC risk prediction and may be particularly useful identifying persons with a < 20 PY history who are at elevated risk for LC.These findings require validation in an external screening population.

DNA methylation at cg05575921, an established biomarker for smoking predicts risk for lung cancer (LC). Although heavy alcohol consumption (HAC) frequently accompanies smoking, the relationship of HAC to overall mortality in those at risk for LC is not well known. Determining the contribution of HAC to mortality in those who smoke is important because HAC is also a major driver of mortality and is potentially treatable. To help answer this question, we examined the relationship of epigenetic biomarkers of smoking (cg05575921) and chronic heavy alcohol consumption (Alcohol T Score, ATS) in a cohort of 92 LC cases and 402 age, sex, ethnicity and smoking history matched controls from the Prostate, Lung, Colorectal and Ovarian (PLCO) Screening Trial to all-cause mortality using proportional hazards survival analysis. We found that ATS values significantly predicted risk for all-cause mortality in those smokers who developed (p < 0.03) and did not develop lung cancer (p < 0.0001). When mortality data were analyzed using median splits, those who did and did not incur lung cancer with ATS values <3.6 lived 5.6 years and 3.2 years more, respectfully, than those with ATS values >3.6. Interestingly, in this group of 494 smokers or former smokers, after adjusting for the occurrence of lung cancer, cg05575921 methylation did not predict mortality. In summary, we found that excessive alcohol consumption is a significant risk factor for all-cause mortality in those at risk for LC and suggest that lung cancer screening efforts to address problem drinking could increase survival.

PURPOSE:Inadequate bowel preparation (IBP) for colonoscopies is associated with missed polyps and cancers, prolonged procedure times, lower colonoscopy completion rates, and need for a repeat procedure. The purposes of this study were to assess: 1) whether impaired cognitive status (measured by an abnormal clock drawing test) was associated with IBP, and 2) the association of participant demographic and clinical characteristics with IBP. METHODS:Cross-sectional cohort study conducted in 3 academic centers. Subjects, 50 to 85 years old, completed 5 stool tests on a single sample and a clock drawing before undergoing a screening or surveillance colonoscopy. Clock drawings were validated by the Mendes-Santos method and Watson method. A generalized linear mixed model was conducted to estimate factors associated with IBP, based on Aronchick bowel preparation score. RESULTS:The 2,016 participants had a mean age of 63 years (SD = 7.95); 1,274 (63%) were female; 119 (6%) had IBP; and 421 (21%) had an abnormal clock drawing. After controlling for age in the multivariable model, the odds of having an IBP versus adequate were 1.44 (95% CI, 0.94-2.22) for those with an abnormal clock drawing score compared with those with a normal score. The only variable significantly associated with IBP was household income, with an odds of 2.48 (95% CI, 1.56-3.95) for household income of <$40,000 compared with income >$80,000. CONCLUSIONS:Lower household income was associated with greater odds of IBP. The association between an abnormal clock drawing score and IBP was not statistically significant.NCT03264898 (clinicaltrials.gov) - Comparative Effectiveness of FITs with Colonoscopy.

Background:Mathematical prediction models (MPMs) based on clinical and radiologist-assessed features have been developed to assist with lung cancer risk assessment for imaging-detected lung nodules. However, MPMs were developed using different datasets, thresholds, and feature sets, making it difficult to cross-compare the published performance metrics and determine prospective performance stability. The aim of this study is to utilize a large lung cancer screening cohort with identified pulmonary nodules to compare the performance of four MPMs, at a standardized sensitivity value, to reduce the false positive rate for lung cancer screening exams. Methods:This retrospective study utilized low-dose computed tomography (LDCT) identified lung nodules from the National Lung Screening Trial (NLST) to evaluate four MPMs [Mayo Clinic (MC), Veterans Affairs (VA), Peking University (PU), and Brock University (BU)]. For cross-comparison, a small NLST sub-cohort (n=270) was used to determine a calibrated decision threshold for each model, targeting a sensitivity for detecting lung cancer of 95%. Performance was evaluated using area under the receiver-operating-characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, and specificity. The calibrated threshold applied to the remaining NLST cohort (n=1,083) was used to demonstrate the stability of performance metrics. Results:A total of 1,353 patients [mean ± standard deviation (SD) age, 62.3±5.2 years; 746 male] were included, of which 122 (9.0%) had a malignant nodule. At the target sensitivity of 95%, the highest testing specificity (correctly identified benigns) was seen in the BU and MC models (55% and 52%, respectively), compared to the VA (45%) and the PU (16%). The AUC-ROCs for BU (83%), MC (83%), PU (76%), and VA (77%) suggest high-moderate performance, while AUC-PR more accurately reflects that all the models have sub-optimal precision (27-33%). Conclusions:Tuning calibration thresholds of existing MPM aids in performance comparison and stability for application in the lung cancer screening setting. However, targeting high sensitivity (95%), the achievable specificity of the MPMs is low (16-55%), which may limit clinical utility.

Purpose Although lung cancer screening (LCS) with low-dose chest CT (LDCT) is recommended for high-risk populations, little is known about how clinical screening compares with research trials. We compared Lung CT Screening Reporting and Data System (Lung-RADS) scores between a nationally screened population from the ACR’s LCS Registry (LCSR) and the National Lung Screening Trial (NLST). Methods This retrospective study included baseline LDCT examinations from the LCSR and NLST. Patient characteristics (age, gender, smoking status, pack-years, and body mass index) were obtained. NLST LDCT results were recoded to Lung-RADS version 1.1. A multivariable multinomial logistic model was used to examine variations in Lung-RADS scores by screening group (LCSR versus NLST) and patient characteristics. Results In all, 686,011 and 26,432 participants from the LCSR and NLST, respectively, were included. Compared with the NLST, the LCSR population was older (mean age [SD]: 64.0 [5.4] versus 61.4 [5.0] years); P < .001) and included more female patients (47.9% versus 40.9%; P < .001), and its patients were more likely to be currently smoking (61.5% versus 48.1%; P < .001). After adjusting for age, gender, smoking history, and body mass index, the LCSR population was more significantly likely to have higher Lung-RADS scores than the NLST (adjusted odds ratio and 95% confidence interval > 1 for Lung-RADS scores 2, 3, 4A, 4B, 4X relative to Lung-RADS 1). Conclusions Lung-RADS scores in clinical LCS are higher than in the NLST, even after adjusting for known confounders such as age and smoking. This would imply higher rates of follow-up testing after LCS and potentially higher cancer rates in the clinically screened population than the NLST.

BACKGROUND:Uptake of lung cancer screening (LCS) in the United States has been limited, and some groups have argued that the unprecedented Centers for Medicare & Medicaid Services (CMS) coverage mandate for shared decision-making (SDM) contributed to the low screening rates. Late in 2021, the CMS initiated an update of its LCS coverage determination, which included 2 public comment periods. RESEARCH QUESTION:What comments were offered by the public about SDM in response to the proposed CMS update and how did CMS address commenters' concerns? STUDY DESIGN AND METHODS:Public comments on SDM from the 2 periods were downloaded into a searchable database and commenter affiliations were categorized. Thematic analysis was used to analyze the verbatim comments. RESULTS:A total of 170 comments were submitted during the initial comment period and 49 during the second, with the largest number coming from individuals affiliated with radiology and/or LCS programs. Ninety-one comments addressed SDM. Recommendations about the SDM visit included complete removal, endorsing its importance without making it mandatory, and retaining the requirement with changes to reduce its administrative burden. Objections to the required SDM visit included the following: it is a barrier to screening initiation, it is a burden for clinicians, it is not required of other cancer screening tests, and the process is too complex. Relevant evidence supporting the objections was lacking. Comments in support of SDM recognized its importance in the context of LCS while proposing changes that allow nonclinical professionals to conduct the SDM visit and allowing for telehealth visits. INTERPRETATION:Commenters raised concerns that the CMS requirement for SDM led to many LCS implementation challenges. In response, the coverage decision was modified to decrease the administrative burden on screening programs while retaining the patient counseling and SDM requirement.

Multicancer early detection (MCED) tests are an emerging technology for cancer screening. MCED tests can detect cancer signals from multiple cancers concurrently in biological samples such as blood, urine, saliva, or other bodily fluids. Some tests can suggest the most likely cancer origin, whereas others report cancer detected somewhere in the body. Although some MCED tests are currently commercially available, none are approved by the Food and Drug Administration or endorsed by any clinical practice guideline or recommendation. Most insurance companies do not currently cover MCED testing. MCED tests have not yet been evaluated for safety and effectiveness in randomized controlled trials. Because patients already are asking for MCED test prescriptions or for interpretation of results from tests acquired elsewhere, clinicians should be prepared to discuss what is known about the benefits, risks, and uncertainties of MCED testing, including performance characteristics in screening populations and preferred follow-up strategies for positive test results. At this time, clinicians should not feel obligated to initiate discussions about MCED testing with their patients. However, clinicians should engage patients who inquire about getting tested or previous MCED test results in shared decision-making, and take the opportunity to offer and help patients complete age- and sex-appropriate guideline-recommended cancer screenings. In this article, the current evidence and issues around MCED testing are summarized, and a framework for shared decision-making discussions is provided.

The U.S. Preventive Services Task Force recommends individualized decision making about prostate cancer screening for men between 55 and 69 years of age. Compared to non-Hispanic Whites, Hispanic men are less likely to report having had a prostate-specific antigen test. While these differences have been attributed to individual- and system-level barriers in early detection and screening of prostate cancer (PCa), less is known about Mexican-origin men perceptions of barriers to PCa screening. Using a community-based participatory research approach, we conducted semistructured interviews (5 men with PCa history; 15 men without PCa history) to characterize Mexican-origin men's knowledge, beliefs, attitudes, and experiences with PCa screening in Yuma County, Arizona. Mexican-origin men viewed genetic predisposition as the main driver of PCa, yet participants highly endorsed PCa screening as reflected by the high rates of PCa screening in our study sample. Further, men spoke to how PCa is a taboo subject among Mexican-origin men and how getting screened for it is often perceived as a threat to their manhood. Finally, Mexican-origin men identified a variety of system-level barriers to PCa screening including lack of health insurance, elevated medical costs, and lack of transportation. The study findings add to an emerging body of literature on determinants of PCa screening among Mexican-origin men. The results of this study have significant implications for public health as they underscore the need for multifaceted interventions that target both individual behaviors and broader social influences to increase PCa screening rates among Mexican-origin men.

Shared decision making (SDM) between health care professionals and patients is essential to help patients make well informed choices about lung cancer screening (LCS). Patients who participate in SDM have greater LCS knowledge, reduced decisional conflict, and improved adherence to annual screening compared with patients who do not participate in SDM. SDM tools are acceptable to patients and clinicians. The importance of SDM in LCS is emphasized in recommendations from professional organizations and highlighted as a priority in the 2022 President's Cancer Panel Report. The updated 2022 national coverage determination from the Centers for Medicare & Medicaid Services reaffirms the value of SDM in offering LCS to eligible beneficiaries. The Shared Decision-Making Task Group of the American Cancer Society National Lung Cancer Roundtable undertook a group consensus process to identify priorities for research and implementation related to SDM for LCS and then evaluated current knowledge in these areas. Priority areas included: (1) developing feasible, adaptable SDM training programs for health care professionals; (2) understanding the impact of alternative health system LCS models on SDM practice and outcomes; (3) developing and evaluating new patient decision aids for use with diverse populations and in varied settings; (4) offering conceptual clarity about what constitutes a high-quality decision and developing appropriate quality measures; and (5) studying the use of prediction-augmented screening to support SDM in practice. Gaps in current research in all areas were observed. The authors conclude with a research and implementation agenda to advance the quality and implementation of SDM for persons who might benefit from LCS.

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (MP12)1 May 2024MP12-15 ERECTILE DYSFUNCTION AND STRESS URINARY INCONTINENCE RATES ARE HIGHER IN VETERANS ELECTING PROSTATECTOMY INSIDE OF THE VETERANS HEALTH ADMINISTRATION (VHA) VERSUS THE COMMUNITY: ANALYZING SURVIVORSHIP CARE AFTER CHOICE LEGISLATION Bradley A. Erickson, Brice Beck, Kelly Miell, Mary Vaughan-Sarrazin, Amanda Swanton, and Richard Hoffman Bradley A. EricksonBradley A. Erickson , Brice BeckBrice Beck , Kelly MiellKelly Miell , Mary Vaughan-SarrazinMary Vaughan-Sarrazin , Amanda SwantonAmanda Swanton , and Richard HoffmanRichard Hoffman View All Author Informationhttps://doi.org/10.1097/01.JU.0001009376.16371.fb.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have previously shown that the VA CHOICE program (VCP) significantly increased the number of men receiving care for prostate cancer (CaP) outside of the VHA, but VPC care was associated with overtreatment (definitive treatment for grade group 1 CaP). We describe how the VCP has affected post-radical prostatectomy (RP) complications and survivorship care. METHODS: A cohort of 9626 men underwent RP between 2014-2018: 67% were performed in the VHA and 33% were performed in CC. New onset persistent erectile dysfunction (ED) and stress urinary incontinence (SUI) were defined as absence of ED/SUI medication/surgery/diagnosis prior to RP with persistence of any/all at 12 months. A multi-variable risk model was created to determine risk of ED and SUI, controlling for patient (e.g., age, diabetes), prostate (e.g., CaP grade, stage), and facility (e.g., robotic surgery) variables. Separate models were then created for access to SUI/ED medical and surgical care. RESULTS: Preexisting ED and SUI was present in 32% and 7%, respectively. After eliminating this cohort, rates of incident persistent ED were 37% and 27% in the VHA and CC cohorts, respectively. The multivariable model showed VHA surgery to be significantly associated with ED diagnosis/treatment (RR 1.3; 1.2-1.4). Rates of persistent SUI were 28% and 13% in the VHA and CC cohorts respectively. The multivariable model showed VHA surgery to be significantly associated with SUI diagnosis/treatment (RR 2.0; 1.8-2.3). In men with ED, med use was equal (RR 1.0), but receipt of implantable penile prostheses was more common in the VHA cohort (RR 3.4 (1.5-7.6)). In men with SUI, receipt of artificial urinary sphincters was more common in the VHA cohort (RR 2.5 (1.3-4.9)). ED/SUI rates were not affected by VA surgical volume or Medicare eligibility. CONCLUSIONS: Rates of ED and SUI diagnosis and treatment are higher in the cohort that undergo prostatectomy in the VHA versus CC. There are three possible explanations: VHA surgery leads to more complications, VHA patients have more intensive survivorship care (leading to more diagnosis/treatment), or unmeasured factors are responsible for the differences. Regardless, the disparities deserve further study to improve survivorship care in our nation's Veterans. Source of Funding: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center- Iowa City (Award#03596) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e206 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Bradley A. Erickson More articles by this author Brice Beck More articles by this author Kelly Miell More articles by this author Mary Vaughan-Sarrazin More articles by this author Amanda Swanton More articles by this author Richard Hoffman More articles by this author Expand All Advertisement PDF downloadLoading ...

This study sought to quantify the contributions of state-level factors including income inequality, state's legislature political control, and Medicaid expansion in new and established Latinx destination states on Latinx individuals' treated hypertension. Mixed-effects logistic regression analyses were conducted to analyze 2017 Behavioral Risk Factor Surveillance System data from 7524 Latinx adults nested within 39 states. Overall, 70% reported being pharmacologically treated for hypertension, and 66% resided in established destination states. Compared with Latinx people in established destination states, Latinx people in new destinations had lower odds of having treated hypertension (odds ratio [OR] = 0.72, 95% CI = 0.54-0.95). Within established Latinx destinations, the odds of treated hypertension were lower in states where legislatures expanded Medicaid than in states that did not expand Medicaid (OR = 0.84, 95% CI = 0.79-0.89). However, after controlling for the effects of individual-level factors, this association was no longer statistically significant. In new Latinx destination states, Medicaid expansion, legislatures' political control, and income inequality were not associated with treated hypertension. The study results highlight the importance of considering both individual- and state-level factors, as the interplay of such factors could hinder the successful implementation of cardiovascular risk reduction interventions.

Black men in the United States experience a substantial and disproportionate burden from prostate cancer. Compared with other racial and ethnic groups, Black men have the highest prostate cancer incidence and mortality rates, have the highest rate of distant-stage cancer, and are diagnosed with cancer at a younger age.1 Microsimulation models suggest that annually screening Black men 45 to 69 years of age could substantially reduce mortality while limiting overdiagnosis.2 The American Urological Association (AUA) and the American Cancer Society (ACS) guidelines have long recommended earlier screening for Black men, beginning at either 40 or 45 years of age depending on family history of prostate cancer.