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Background: Fatty liver disease (FLD) is associated with increased risk for hepatocellular carcinoma (HCC) and is associated with rising rates of diabetes and obesity. The prevalence of FLD is rising among Asian American and Pacific Islanders (AAPIs) and Latinos. This study examined health literacy, knowledge, and risk factors for FLD among AAPIs and Latinos in Los Angeles. Methods: Data from in-person interviews and clinical measures (body mass index (BMI), body fat percentage, and blood pressure) were obtained from adults aged 18-82 years at four health fairs from November 2018 to March 2019. Interviews assessed knowledge about FLD, access to health resources, and satisfaction with current physician. Correct responses to knowledge questions were summed to generate a FLD knowledge score. Linear regression models were used to examine the association between knowledge score and age, sex, and race/ethnicity. Results: A total of 102 subjects were AAPI and 33 were Latino. Over 65% of participants had heard of FLD but demonstrated limited knowledge about FLD. Only 24% of subjects reported receiving FLD resources in their preferred language. Most subjects failed to identify several risk factors and key symptoms of FLD. Mean knowledge score for subjects who had heard of FLD was 7.58 (95% CI 7.15-8.01) out of a possible 16 points, and for those who had not who had not heard of FLD it was 5.71 (5.00-6.42) (p

Individuals diagnosed with colorectal adenomas with high-risk features during screening colonoscopy have increased risk for the development of subsequent adenomas and colorectal cancer. While US guidelines recommend surveillance colonoscopy at 3 years in this high-risk population, surveillance uptake is suboptimal. To inform future interventions to improve surveillance uptake, we sought to assess surveillance rates and identify facilitators of uptake in a large integrated health system. We utilized a cohort of patients with a diagnosis of ≥ 1 tubular adenoma (TA) with high-risk features (TA ≥ 1 cm, TA with villous features, TA with high-grade dysplasia, or ≥ 3 TA of any size) on colonoscopy between 2013 and 2016. Surveillance colonoscopy completion within 3.5 years of diagnosis of an adenoma with high-risk features was our primary outcome. We evaluated surveillance uptake over time and utilized logistic regression to detect factors associated with completion of surveillance colonoscopy. The final cohort was comprised of 405 patients. 172 (42.5%) patients successfully completed surveillance colonoscopy by 3.5 years. Use of a patient reminder (telephone, electronic message, or letter) for due surveillance (adjusted odds = 1.9; 95%CI = 1.2–2.8) and having ≥ 1 gastroenterology (GI) visit after diagnosis of an adenoma with high-risk features (adjusted odds = 2.6; 95%CI = 1.6–4.2) significantly predicted surveillance colonoscopy completion at 3.5 years. For patients diagnosed with adenomas with high-risk features, surveillance colonoscopy uptake is suboptimal and frequently occurs after the 3-year surveillance recommendation. Patient reminders and visitation with GI after index colonoscopy are associated with timely surveillance completion. Our findings highlight potential health system interventions to increase timely surveillance uptake for patients diagnosed with adenomas with high-risk features.

Background Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and cirrhosis. NAFLD is mediated by changes in lipid metabolism and known risk factors include obesity, metabolic syndrome, and diabetes. The aim of this study was to better understand differences in the lipid composition of individuals with NAFLD compared to controls, by performing direct infusion lipidomics on serum biospecimens from a cohort study of adults in Mexico. Methods A nested case-control study was conducted with a sample of 98 NAFLD cases and 100 healthy controls who are participating in an on-going, longitudinal study in Mexico. NAFLD cases were clinically confirmed using elevated liver enzyme tests and liver ultrasound or liver ultrasound elastography, after excluding alcohol abuse, and 100 controls were identified as having at least two consecutive normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ( Results NAFLD cases had differences in total amounts of serum cholesterol esters, lysophosphatidylcholines, sphingomyelins, and triacylglycerols (TAGs), however, other lipid subclasses were similar to controls. Analysis of individual TAG species revealed increased incorporation of saturated fatty acyl tails in serum of NAFLD cases. After adjusting for age, sex, body mass index, and PNPLA3 genotype, a combined panel of ten lipids predicted case or control status better than an area under the ROC curve of 0.83. Conclusions These preliminary results indicate that the serum lipidome differs in patients with NAFLD, compared to healthy controls, and suggest that assessing the desaturation state of TAGs or a specific lipid panel may be useful clinical tools for the diagnosis of NAFLD.

Purpose Young adulthood is characterized by changes in health care decision-making, insurance coverage, and sexual risk. Although the human papillomavirus (HPV) vaccine is now approved for adults up to age 45, and catch-up vaccination is currently recommended up through age 26, vaccination rates remain low in young adults. This study explored perspectives on HPV vaccination among young adults receiving care at the student health center of a large public university. Methods We conducted semi-structured interviews (n = 27) and four focus groups with female and male undergraduate and graduate students (n = 18) and semi-structured interviews with health care providers (n = 6). Interviews and focus groups explored perceived risk of HPV infection, benefits of the HPV vaccine, and motivations for and barriers to HPV vaccination. Results Many young adults cited their parents’ views and recommendations from medical providers as influential on their decision-making process. Students perceived that cervical cancer prevention was a main benefit of the HPV vaccine and sexual activity was a risk factor for HPV infection. Students often lacked knowledge about the vaccine’s benefits for males and expressed some concerns about the safety and side effects of a vaccine perceived as new. Logistical barriers to vaccination included uncertainty over vaccination status and insurance coverage for the vaccine, and concerns about balancing the vaccine schedule with school obligations. Providers’ vaccine recommendations were impacted by health system factors, including clinical infrastructure, processes for recommending and documenting vaccination, and office visit priorities. Suggested vaccination promotion strategies included improving the timing and messaging of outreach efforts on campus and bolstering clinical infrastructure. Conclusions Although college may be an opportune time to reach young adults for HPV vaccination, obstacles including navigating parental influence and independent decision-making, lack of awareness of vaccination status, and numerous logistical and system-level barriers may impede vaccination during this time.

PurposeCancer survivors diagnosed at an early age remain at risk for cancer recurrence and other chronic diseases. This study assessed engagement in surveillance for recurrence, cancer screening, and other recommended preventive health services among breast and colorectal cancer survivors with early-onset disease (≤ 50years) who were diagnosed in California.MethodsBreast and colorectal cancer survivors diagnosed with early-onset cancer between 1999 and 2009 were identified through the California Cancer Registry, the state-based cancer registry, and surveyed. Multivariable regression analyses were used to assess correlates of receipt of cancer surveillance, cancer screening, and other preventive health services.ResultsOf the 497 survivors that were invited to participate in the study, 156 completed the survey for a response rate of 31%. The sample was 50years of age on average (range 32-69years) with a mean time since diagnosis of 9years. The majority of the sample (71%) was a racial/ethnic minority (24% Latino, 15% African American, 29% Asian). Overall, 80% received appropriate surveillance for recurrence, and 72% received recommended screening for early detection of other cancers (breast, cervical, colorectal). Increasing age was associated with lower likelihood of early detection screening (adjusted odds ratio (aOR) 0.28, 95% confidence interval (CI) 0.11-0.69), and higher income was associated with a greater likelihood (aOR 4.89, 95% CI 1.62-14.81). Screening rates were highest for blood pressure (96%), cholesterol (86%), and diabetes (81%), followed by dental visits (64%) and flu vaccination (35%). Greater use of recommended preventive health services was associated with increasing age, female sex, higher education level, and having health insurance.ConclusionsAlthough the majority of survivors received appropriate surveillance for recurrence, engagement in other preventive health services varied substantially.Implications for cancer survivorsEfforts are needed to address gaps in the use of recommended cancer screening and preventive health services among cancer survivors, particularly survivors with early-onset disease who may be at increased risk for additional cancers and common chronic conditions over their lifetime.

Background and Aims Determining surveillance intervals for patients with colorectal polyps is critical but time-consuming and challenging to do reliably. We present the development and assessment of a pipeline that leverages natural language processing techniques to automatically extract and analyze relevant polyp findings from free-text colonoscopy and pathology reports. Using this information, we categorized individual patients into 6 postcolonoscopy surveillance intervals defined by the U.S. Multi-Society Task Force on Colorectal Cancer. Methods Using a set of 546 randomly selected colonoscopy and pathology reports from 324 patients in a single health system, we used a combination of statistical classifiers and rule-based methods to extract polyp properties from each report type, associate properties with unique polyps, and classify a patient into 1 of 6 risk categories by integrating information from both report types. We then assessed the pipeline’s performance by determining the positive predictive value (PPV), sensitivity, and F-score of the algorithm, compared with the determination of surveillance intervals by a gastroenterologist. Results The pipeline was developed using 346 reports (224 colonoscopy and 122 pathology) from 224 patients and evaluated on an independent test set of 200 reports (100 colonoscopy and 100 pathology) from 100 patients. We achieved an average PPV, sensitivity, and F-score of .92, .95, and .93, respectively, across targeted entities for colonoscopy. Pathology extraction achieved a PPV, sensitivity, and F-score of .95, .97, and .96. The system achieved an overall accuracy of 92% in assigning the recommended interval for surveillance colonoscopy. Conclusions This study demonstrates the feasibility of using machine learning to automatically extract findings and classify patients to appropriate risk categories and corresponding surveillance intervals. Incorporating this system can facilitate proactive and timely follow-up after screening colonoscopy and enable real-time quality assessment of prevention programs and providers.

Hispanics represent the largest and one of the fastest growing minority populations in the U.S. and have lower survival from colorectal cancer (CRC) than non-Hispanic Whites (NHW). We aimed to examine screening modalities, predictors, and regional disparities among Hispanics and NHW in the U.S. by conducting a cross-sectional analysis of Hispanic participants age 50 to 75 from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey. The primary outcome was self-reported CRC screening status. We used the Rao-Scott Chi-square test to compare screening rates and modalities in NHWs and Hispanics. We also used univariable and multivariable logistic regression to determine predictors of screening among Hispanics and calculated Hispanic-NHW screening rate differences for each U.S. state/territory as a measure of regional screening disparities. The screening rate was 53.4% for Hispanics (N=12,395), compared to 70.4% for NHWs (N=186,331) (p&nbsp

Background: Liver cancer is one of the most rapidly increasing cancers in the United States, and hepatocellular carcinoma (HCC) is its most common form. Disease burden and risk factors differ by sex and race/ethnicity, but a comprehensive analysis of disparities by socioeconomic status (SES) is lacking. We examined the relative impact of race/ethnicity, sex, and SES on HCC incidence, stage, and survival. Methods: We used Surveillance, Epidemiology, and End Results (SEER) 18 data to identify histologically confirmed cases of HCC diagnosed between January 1, 2000 and December 31, 2015. We calculated age-adjusted HCC incidence, stage at diagnosis (local, regional, distant, unstaged), and 5-year survival, by race/ethnicity, SES and sex, using SEER*Stat version 8.3.5. Results: We identified 45,789 cases of HCC. Incidence was highest among low-SES Asian/Pacific Islanders (API; 12.1) and lowest in high-SES Whites (3.2). Incidence was significantly higher among those with low-SES compared with high-SES for each racial/ethnic group (P < 0.001), except American Indian/Alaska Natives (AI/AN). High-SES API had the highest percentage of HCC diagnosed at the local stage. Of all race/ethnicities, Blacks had the highest proportion of distant stage disease in the low- and high-SES groups. Survival was greater in all high-SES racial/ethnic groups compared with low-SES (P < 0.001), except among AI/ANs. Black, low-SES males had the lowest 5-year survival. Conclusions: With few exceptions, HCC incidence, distant stage at diagnosis, and poor survival were highest among the low-SES groups for all race/ethnicities in this national sample. Impact: HCC prevention and control efforts should target low SES populations, in addition to specific racial/ethnic groups.

Background & Aims Colorectal cancer (CRC) is major cause of cancer-related mortality in the United States. Screening, however, is suboptimal and there are disparities in outcomes. After health policy changes and national efforts to increase rates of screening and address inequities, we aimed to examine progress towards eliminating racial and ethnic disparities in CRC screening. Methods We conducted a repeated cross-sectional analysis of average-risk adults (age 50–75 years) included in the behavioral risk factors surveillance system survey. The main outcome was CRC screening status. We determined screening rates overall and by race and ethnicity (1 variable) for each survey year from 2008 through 2016 and used Joinpoint analyses to determine significant trends in rates over time by race and ethnicity. We also examined screening modalities used overall and by race and ethnicity. Results We analyzed data from 1,089,433 respondents. Screening uptake was 61.1% in 2008 and 67.6% in 2016 (P Conclusions In a cross-sectional analysis of average-risk adults, we found that although rates of CRC screening have increased overall since 2008, they have increased disproportionately in each racial and ethnic group, and disparities in screening uptake persist.

Background: Although overall cancer incidence and mortality have been declining in the United States (US) in recent years, liver cancer incidence and mortality have tripled since 1980. In 2019, an estimated 42,000 new cases of liver cancer will be diagnosed and there will be nearly 32,000 deaths from liver cancer. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, and it generally progresses from chronic liver disease, such as cirrhosis. HCC and its etiologies are not evenly distributed in the population, with racial/ethnic minorities bearing a disproportionate burden of disease. Asians and Latinos currently have the highest incidence rates of HCC in the US. To investigate these disparities, we identified a sample of HCC patients at a large academic health system to compare their sociodemographic characteristics and clinical and behavioral risk factors by race/ethnicity. Methods: We used electronic health record (EHR) data to identify a cohort of primary care patients who had at least two outpatient visits to a UCLA primary care provider, at least one year apart, from 2006 to 2018, and who were between the ages of 18-75 years at the time of the visits (n = 280,619). Initial descriptive analyses were conducted to profile HCC cases by key demographics, including age, sex, and race/ethnicity, as well as by co-diagnoses, which may represent key contributing causes to the development of HCC. Results: In the primary care cohort, a total of 749 patients (0.002%) had a diagnosis of HCC. Prevalence of HCC was highest among Asians (0.6%), followed by African Americans (0.4%), Latinos (0.4%), and was lowest among Whites (0.2%). Among patients classified as other or unknown race the HCC prevalence was 0.15%, and 0.04%, respectively. The most common co-diagnoses among the HCC cases were: cirrhosis (58.9%), hepatitis C (HCV; 45.9%), hepatitis B (HBV; 26.3%), non-alcoholic fatty liver disease (NAFLD; 24.0%), non-alcoholic steatohepatitis (NASH; 23.0%), and alcoholic hepatitis (19.1%). Cirrhosis was the most common co-diagnosis for all racial/ethnic groups (Blacks=66.1%, Latinos=82.2%, Whites=54.8%), except Asians (49.1%). HBV was the most common co-diagnosis among Asians (62.9%), while HCV was the second most common co-diagnosis among Blacks (64.5%), Latinos (54.2%), and Whites (44.1%). Latinos were the most likely to have a co-diagnosis of alcoholic hepatitis (37.3%). Conclusion: We observed distinct patterns of co-diagnoses with precursor conditions by race/ethnicity in this sample of HCC cases. Although the cross-sectional nature of these analyses preclude attributing cause to co-diagnoses, these results are consistent with existing epidemiological data. Future longitudinal analyses will examine the timeline between diagnosis with HCC and the respective etiologies, and investigate factors that may facilitate or impede disease progression, which can inform future interventions to reduce racial/ethnic disparities in liver cancer. Citation Format: Yvonne N Flores, Beth A Glenn, Folasade May, Lina Tieu, Carrie R Wong, Lucia Chen, Francisco Durazo, Roshan Bastani. Developing precision medicine approaches to address liver cancer disparities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D108.

Introduction: Coverage of routine cervical cancer screening in Malawi is very low, even though it has the highest cervical cancer burden in the world. We performed a multi-level assessment of Malawian women’s knowledge and perceptions of cervical cancer risk and screening, following recent scale-up of screening and treatment programs. Methods: Based on the Multi-Level Health Outcomes Framework, we conducted interviews with 60 adult Malawian women at facilities that offer cervical cancer screening; eligible participants were recruited regardless of HIV status or history of cervical cancer screening. Trained female researchers asked women about their experiences with and opinions of cervical cancer disease and screening. Interviews were audio recorded with permission, transcripts were translated from Chichewa (the local language) to English, and a theory-informed codebook was developed. Analysis focused on thematic differences across groups by age, HIV status and screening history. Results: Half of the sample (n=30) had either never been screened for cervical cancer or were at the facility for their first-ever screen. Most women said that cervical cancer is dangerous, and many knew someone affected. Many women spoke about the importance of screening for prevention of cancer. Risk factors were generally well-understood, including increased risk with HIV, although this was misunderstood by some HIV-negative women to mean they were not at risk. Gender issues were highly salient, relating to sexual transmissibility, husbands’ support of screening, and modesty if screened by a male clinician. Women had commonly heard rumors about the procedure being painful or dangerous. Conclusions: Despite high knowledge among Malawian women about cervical cancer disease and the importance of screening, there remain significant challenges. This study highlights the role of interpersonal and system-level barriers. Future work should work to strengthen service delivery, target social networks and spouses, and develop targeted language for HIV-positive and -negative groups especially in high-burden settings. Citation Format: Corrina Moucheraud, Paul Kawale, Savel Kafwafwa, Roshan Bastani, Risa M Hoffman. Cervical cancer knowledge and perceptions among women in Malawi: Qualitative data from a high-burden, low-resource setting [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C121.

Highlights • Malawian women are knowledgeable about cervical cancer risk and screening benefits. • Social networks play an important role in cervical cancer screening behaviors. • Gender dynamics and spousal support shape screening decisions for some women. • Interventions should target these interpersonal factors. • Unique messages about screening may be required for HIV-positive and -negative women., Adoption of routine cervical cancer screening in Malawi is very low, even though it has the highest cervical cancer burden in the world. We performed a multi-level assessment of Malawian women’s knowledge and perceptions of cervical cancer risk and screening. Using the Multi-Level Health Outcomes Framework, we conducted interviews with 60 adult Malawian women aged 18–62 at facilities with cervical cancer screening. Eligible participants were recruited regardless of HIV status or history of screening, and asked about their experiences with cervical cancer disease and screening. Interviews were audio recorded and a theory-informed codebook was developed. Analysis focused on thematic differences across groups by age, HIV status, and screening history. Half of the sample (n = 30) had either never been screened for cervical cancer or were at the facility for their first-ever screen. Most women said that cervical cancer is dangerous, and many knew someone affected. Many women spoke about the importance of screening for prevention of cancer. Risk factors were generally well-understood, including increased risk with HIV, although this was misunderstood by some HIV-negative women to mean they were not at risk. Social networks were identified as a key determinant of screening, and gender issues were likewise highly salient. Despite high knowledge levels about cervical cancer, there remain significant challenges to improving screening, including interpersonal and system-level barriers. Future work should strengthen service delivery, target social networks and intimate partners, and develop targeted communication strategies for HIV-positive and -negative groups, especially in high-burden settings.

Barriers to obtaining breast cancer prevention knowledge and breast cancer screening have been noted among D/deaf women. A randomized controlled trial (RCT) is described that tested a culturally and linguistically tailored breast cancer education program conducted among a racially/ethnically diverse sample of 209 D/deaf women age 40 years or older. The study focused on D/deaf women with no more than a secondary education, a population at relatively high risk for incomplete breast health knowledge and services. This population's inadequate breast cancer knowledge and screening practices and the value of the education program were confirmed. Knowledge increased from -baseline to 12-month follow-up in the intervention group, and in some instances the control group; increased intention to get a mammogram was observed in the intervention group. Possible reasons for the few significant intervention/control group differences at 12 months were examined. Materials from the RCT are available online.

PurposeTo assess weight status, physical activity, and dietary behaviors in an ethnically-diverse sample of breast and colorectal cancer survivors with early onset disease (≤ 50 years).MethodsBreast and colorectal cancer survivors, diagnosed between 1999 and 2009 with early-stage cancer diagnosed by 50years of age, were identified through a population-based cancer registry and surveyed. Descriptive and regression analyses were conducted to characterize the sample and identify correlates of lifestyle behaviors.FindingsThe majority of participants (n = 156) were female (83%), insured (84%), and racial/ethnic minorities (29% Asian, 24% Latino, 15% African American). Participants' mean age at response was 50years and mean time since diagnosis was 9years. Over half of survivors were overweight or obese. Few participants reported engaging in regular physical activity (31%) and adhering to minimum guidelines for fruit and vegetable consumption (32%). A substantial proportion of survivors consumed fast food in the past week (75%) and nearly half (48%) reported daily consumption of sugar-sweetened beverages. Lower income was associated with inadequate fruit and vegetable intake. Fast food and sugar-sweetened beverage consumption was significantly higher among racial/ethnic minority survivors compared to non-Latino whites.ConclusionsHigh prevalence of overweight and suboptimal adherence to recommended nutrition and physical activity behaviors were observed among cancer survivors with early onset disease. Cancer survivors diagnosed at a young age may benefit from targeted interventions to address overweight and suboptimal nutrition and physical activity.

Background: In the United States, Korean immigrants experience a disproportionately high burden of chronic hepatitis B (HBV) viral infection and associated liver cancer compared with the general population. However, despite clear clinical guidelines, HBV serologic testing among Koreans remains persistently suboptimal. Methods: We conducted a cluster-randomized trial to evaluate a church-based small group intervention to improve HBV testing among Koreans in Los Angeles. Fifty-two Korean churches, stratified by size (small, medium, large) and location (Koreatown versus other), were randomized to intervention or control conditions. Intervention church participants attended a single-session small-group discussion on liver cancer and HBV testing, and control church participants attended a similar session on physical activity and nutrition. Outcome data consisted of self-reported HBV testing obtained via 6-month telephone follow-up interviews. Results: We recruited 1,123 individuals, 18 to 64 years of age, across the 52 churches. Ninety-two percent of the sample attended the assigned intervention session and 86% completed the 6-month follow-up. Sample characteristics included were as follows: mean age 46 years, 65% female, 97% born in Korea, 69% completed some college, and 43% insured. In an intent-to-treat analysis, the intervention produced a statistically significant effect (OR = 4.9, P < 0.001), with 19% of intervention and 6% of control group participants reporting a HBV test. Conclusion: Our intervention was successful in achieving a large and robust effect in a population at high risk of HBV infection and sequelae. Impact: The intervention was fairly resource efficient and thus has high potential for replication in other high-risk Asian groups. Cancer Epidemiol Biomarkers Prev; 24(9); 1341–9. ©2015 AACR.

Author(s): Wallner, Lauren P; Slezak, Jeffrey M; Loo, Ronald K; Bastani, Roshan; Jacobsen, Steven J | Abstract: CONTEXT:Few studies have assessed the longer-term quality of preventive care in prostate cancer (PCa) survivors. OBJECTIVE:To compare the rates of preventive services among PCa survivors five years before and after diagnosis, to men without PCa. DESIGN:Men enrolled in Kaiser Permanente Southern California with newly diagnosed PCa (2002-2008) were matched 1:1 to men without a PCa diagnosis on age, race, and timing of prostate-specific antigen test (N = 31,180). The use of preventive services, including colorectal cancer screening, diabetes tests, lipid panels, and influenza and pneumococcal vaccinations was assessed 5 years before and after diagnosis (or index date for controls). MAIN OUTCOME MEASURES:Relative rates (RRs) of use were calculated for cases and controls separately and compared using Poisson regression, adjusting for comorbidities and outpatient utilization in 2014. RESULTS:Overall, the rates of preventive services were lower among men with PCa vs men without PCa. However, in the 5 years after diagnosis, rates of preventive service use for all services were greater among PCa survivors vs men without PCa (colorectal cancer: RR = 1.05, 95% confidence interval [CI] = 1.01-1.10; lipids: RR = 1.10, 95% CI = 1.08-1.11; hemoglobin A1C: RR = 1.17, 95% CI = 1.14-1.19; glucose: RR = 1.24, 95% CI = 1.23-1.26; influenza vaccine: RR = 1.05, 95% CI = 1.03-1.07; pneumococcal vaccine: RR = 1.03, 95% CI = 0.97-1.09). CONCLUSION:Delivery of preventive care improved after PCa diagnosis, with survivors receiving comparable preventive care to men without PCa during the five years following diagnosis.

Many professional organizations recommend skin self-examination (SSE) as a tool for early detection of malignancy among melanoma survivors, a growing population that is at increased risk for new or recurrent melanoma. This study examined the frequency and correlates of SSE use among melanoma survivors. Additionally, we assessed skin exam use among children of survivors, who are at elevated lifetime risk for the disease. The California Cancer Registry was used to identify melanoma survivors, who were contacted, screened for eligibility, and invited to participate in a survey. The survey, administered by mail, web, or telephone, assessed a broad range of topics related to melanoma prevention in high-risk families. The present study focuses on skin examination practices of survivors and their children and potential correlates of these practices. Among a sample of 316 melanoma survivors, fewer than one in five participants performed monthly skin self-exams, a lower rate than that observed in previous studies. Although greater family history of melanoma, use of skin protection strategies, and the perceived severity of melanom were associated with more frequent use of skin self-exams, these relationships disappeared in adjusted analyses. Participants reported unexpectedly frequent use of skin examinations for their children despite the lack of professional guidelines for this practice. Interventions are needed to improve skin self-examination practices among melanoma survivors and to counsel parents about optimal melanoma prevention strategies for their children.

We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.

© 2014 Society for Adolescent Health and Medicine. Conclusions Nationwide, states responded to the new HPV vaccine by introducing policies designed to increase the availability of information about the vaccine, provide funding, and regulate private insurance coverage rather than require vaccination for school entry.Purpose To examine the policies state governments pursued and enacted across the United States in the 5-year period after the U.S. Food and Drug Administration licensed the human papillomavirus (HPV) vaccine in 2006, including the timing and number of bills introduced, the policies proposed, and the legislative success of HPV vaccine policy proposals.Methods Content abstraction and analysis of state-level HPV vaccine-related bills across the 50 states and the District of Columbia introduced between 2006 and 2010.Results All but five states (Alaska, Delaware, Idaho, New Hampshire, and Wyoming) introduced HPV vaccine bills between 2006 and 2010. Two-thirds of all bills were introduced in 2007. In all, 141 bills were introduced and 23% or 32 bills were enacted. Of the bills that were enacted, 43.8% provided information for parents and schools about the vaccine; 37.5% provided public financing for HPV vaccines; 34.4% were classified as other policies; 25% created awareness campaigns; 25% required private insurance coverage of the HPV vaccination; 12.5% included voluntary vaccination, and 9.4% mandated vaccination for school entry. One bill reversed prior mandatory vaccination policies. Overall, 91% of enacted HPV vaccine bills did not refer to mandated vaccinations but adopted alternate policy strategies in response to the availability of the new HPV vaccine.

Background: Limited scientific evidence is available regarding D/deaf women's breast cancer knowledge and early detection practices, as well as about how to increase D/deaf women's breast cancer control practices. Objective/hypothesis: To assess baseline breast cancer knowledge and practices among a sample of D/deaf women recruited into a randomized controlled trial of a breast cancer education program developed for this population. Methods: A written and signed (American Sign Language) survey was administered to a racially/ethnically diverse sample of 209 D/deaf women, 40+ years old, with lower levels of education, recruited in California between October 2008 and May 2009. Results: There were misconceptions about breast cancer risk factors, screening, and treatment; only 64.2% of respondents correctly identified the purpose of mammography. Mammography in the prior 2 years was reported by 57.3% of the sample, by 69.8% of White women, and by 43.5% of women from other racial/ethnic groups. Rates also varied by education, having seen a physician in the prior year, and type of insurance. Conclusions: This study underscores significant gaps in breast cancer screening knowledge and practices, communication issues in health care settings, and unmet needs for tailored health information and materials in this population. Challenges faced in conducting the research needed to develop and test such programs are noted. © 2013 Elsevier Inc. All rights reserved.

Cambodian Americans have high rates of chronic hepatitis B virus (HBV) infection. However, only about one-half of Cambodian Americans have been serologically tested for HBV. We conducted a randomized controlled trial to evaluate the impact of a lay health worker (LHW) intervention on HBV testing and knowledge levels among Cambodian Americans. The study group included 250 individuals who participated in a community based survey in metropolitan Seattle and had not been tested for HBV. Experimental group participants received a LHW intervention addressing HBV and control group participants received a LHW intervention addressing physical activity. Trial participants completed a follow-up survey 6 months after randomization. Over four-fifths (82 %) of randomized individuals participated in a LHW home visit and the follow-up survey response rate was 80 %. Among participants with follow-up data, 22 % of the experimental group and 3 % of the control group reported HBV testing (p < 0.001). The experimental and control group testing difference remained significant in an intent-to-treat analysis. The experimental group was significantly more likely than the control group to know that Cambodians have higher rates of HBV infection than whites, HBV cannot be spread by eating food prepared by an infected person, HBV cannot be spread by sharing chopsticks, and HBV cannot be spread by shaking hands. Our findings indicate LHW interventions are acceptable to Cambodian Americans and can positively impact both HBV testing and knowledge levels.

Background: There are long-standing black–white disparities in colorectal cancer incidence and outcomes in the United States. Incidence and stage at diagnosis reflect the impact of national efforts directed at colorectal cancer prevention and control. We aimed to evaluate trends in black–white disparities in both indicators over four decades to inform the future direction of prevention and control efforts. Methods: We used Surveillance, Epidemiology, & End Results (SEER) data to identify whites and blacks with histologically confirmed colorectal cancer from January 1, 1975 through December 31, 2012. We calculated the age-adjusted incidence and the proportion of cases presenting in late stage by race and year. We then calculated the annual percentage change (APC) and average APC for each indicator by race, examined changes in indicators over time, and calculated the incidence disparity for each year. Results: There were 440,144 colorectal cancer cases from 1975 to 2012. The overall incidence decreased by 1.35% and 0.46% per year for whites and blacks, respectively. Although the disparity in incidence declined from 2004 to 2012 (APC = −3.88%; P = 0.01), incidence remained higher in blacks in 2012. Late-stage disease declined by 0.27% and 0.45% per year in whites and blacks, respectively. The proportion of late-stage cases became statistically similar in whites and blacks in 2010 (56.60% vs. 56.96%; P = 0.17). Conclusions: Black–white disparities in colorectal cancer incidence and stage at presentation have decreased over time. Impact: Our findings reflect the positive impact of efforts to improve colorectal cancer disparities and emphasize the need for interventions to further reduce the incidence gap. Cancer Epidemiol Biomarkers Prev; 26(5); 762–8. ©2016 AACR.

Mexican and Mexican-American women bear high cervical cancer burdens, yet relationships between mothers' experiences of vaccinating daughters against cervical cancer-causing human papillomavirus (HPV) on both sides of the border are unknown. We surveyed 400 Mexican-born women in Oxnard, California, United States and Cuernavaca, Morelos, Mexico, about their beliefs and practices regarding daughters' HPV vaccination, conducting in-depth interviews with 35 participants. Contextualizing interview findings in survey data, we identify key factors influencing mothers' experiences regarding daughters' HPV vaccination in both countries. Although US acculturation influenced some participants' concerns, US and Mexico participants overwhelmingly desired eventual vaccination; structural rather than cultural barriers limited vaccine uptake.

Cancer screening tests such as mammograms, Pap smears, and colonoscopies can help detect cancer at an early stage, before symptoms appear. Some screening tests such as colonoscopy and Pap smears can also detect precancerous abnormal tissue, which if removed can prevent the occurrence of cancer. Generally, the earlier cancer is detected, the easier it is to treat. Survival and mortality outcomes are also much better for cancer detected at an early versus late stage. However, in addition to benefits, some screening tests carry risks, and finding the cancer early does not always improve the person’s health or help the person live longer [1].

Context Screening reduces mortality from breast, cervical, and colorectal cancers. The Guide to Community Preventive Services previously conducted systematic reviews on the effectiveness of 11 interventions to increase screening for these cancers. This article presents results of updated systematic reviews for nine of these interventions. Evidence acquisition Five databases were searched for studies published during January 2004-October 2008. Studies had to (1) be a primary investigation of one or more intervention category; (2) be conducted in a country with a high-income economy; (3) provide information on at least one cancer screening outcome of interest; and (4) include screening use prior to intervention implementation or a concurrent group unexposed to the intervention category of interest. Forty-five studies were included in the reviews. Evidence synthesis Recommendations were added for one-on-one education to increase screening with fecal occult blood testing (FOBT) and group education to increase mammography screening. Strength of evidence for client reminder interventions to increase FOBT screening was upgraded from sufficient to strong. Previous findings and recommendations for reducing out-of-pocket costs (breast cancer screening); provider assessment and feedback (breast, cervical, and FOBT screening); one-on-one education and client reminders (breast and cervical cancer screening); and reducing structural barriers (breast cancer and FOBT screening) were reaffirmed or unchanged. Evidence remains insufficient to determine effectiveness for the remaining screening tests and intervention categories. Conclusions Findings indicate new and reaffirmed interventions effective in promoting recommended cancer screening, including colorectal cancer screening. Findings can be used in community and healthcare settings to promote recommended care. Important research gaps also are described.

The goal of this pilot study was to assess sun protection practices and correlates among children with a family history of melanoma, a high risk and understudied group. Sixty-eight melanoma cases, recruited through the Los Angeles County cancer registry, completed a survey. Survivors provided data on 110 children (mean age = 8.11 years). Although most children used sunscreen (79 %), half experienced a recent sunburn. The mean sun protection level for the sample was similar to levels observed among average risk children. Efforts to reduce sunburn frequency and improve sun protection among these vulnerable children appear warranted.

Cambodian Americans have an elevated risk of liver cancer. This health disparity is attributable to high rates of hepatitis B virus (HBV) infection. Our study examined factors associated with HBV testing among Cambodian men and women. A population-based survey was conducted in the Seattle area. The Health Behavior Framework guided our survey instrument development. We attempted to interview a man and a woman in each household. The sample included 300 men and 367 women. About one-half of the male (45%) and female (54%) respondents had been tested for HBV. Two factors were independently associated with testing among men and women: a doctor had recommended testing and had asked a doctor for testing. Knowing that someone who looks and feels healthy can spread HBV was independently associated with testing among men. Low levels of HBV testing remain a public health problem among Cambodians. Interventions should improve patient-provider communication by encouraging providers who serve Cambodians to recommend HBV testing, as well as by empowering Cambodians to ask for testing.

Latinos in the US are disproportionately affected by chronic liver disease, which is the sixth most common cause of death among this group. In Mexico, cirrhosis and other liver diseases are the fourth leading cause of general mortality. The objective of this study was to contrast the liver disease risk factors, knowledge, and prevention practices reported among separate samples of Mexicans living in Los Angeles, CA and in Cuernavaca, Mexico. We assessed the prevalence of specific risk factors (body mass index, waist circumference, and alcohol consumption), the level of knowledge about liver disease in general, hepatitis B (HBV), and hepatitis C (HCV), as well as prevention activities such as screening and vaccination. Data were collected from in-person interviews and anthropometric measures obtained from Mexican adults aged 18-70 years. Chi-square and t tests were used to compare the results between groups. Numerous similarities were observed in the bi-national samples, including high prevalence of obesity, abdominal obesity, and high levels of alcohol consumption. Most participants in both countries recognized that excessive alcohol consumption is a risk factor for liver disease, but only 60% correctly identified hepatitis C, being overweight or obese, or having diabetes as risk factors. Few participants reported having been screened for HBV or HCV, vaccinated for HBV, or having the intention of getting screened for HBV or HCV. US participants reported significantly higher levels of prevention activities and screening intentions than those in Mexico. Identifying the specific risk factors, levels of knowledge and prevention activities that affect specific racial/ethnic populations is important in order to effectively target efforts to prevent liver disease.

Women of Southeast Asian descent have higher cervical cancer incidence rates than any other group. Widespread use of HPV vaccination could prevent up to 70% of cervical cancers. There is little published information addressing HPV vaccination uptake among Asian Americans. We conducted a survey of Cambodian women with daughters who were age-eligible for HPV vaccination. Survey items addressed HPV vaccination barriers, facilitators, and uptake. Only 26% of the survey participants reported any of their age-eligible daughters had received vaccination, and only 40% reported a previous physician recommendation for vaccination. Higher levels of vaccine uptake were strongly associated with having received a doctor’s recommendation for vaccination (p < 0.001) and having asked a doctor for vaccination (p = 0.002). HPV vaccine uptake was relatively low in our Cambodian study group. Educational initiatives should encourage health care providers who serve Cambodian families to recommend HPV vaccination and empower Cambodian mothers to ask their daughters’ doctors for vaccination.

Background: The introduction of human papillomavirus (HPV) vaccines represents a breakthrough in the primary prevention of cervical cancer. However, little is known about vaccination uptake and correlates among low-income, ethnic minority, and immigrant populations in the U.S. who may benefit most from the vaccine. Methods: Telephone interviews (N = 490) were conducted in six languages between January and November 2009 among mothers of vaccine-eligible girls (ages 9–18) using the Los Angeles County Department of Public Health, Office of Women's Health service referral hotline. HPV and vaccine awareness, knowledge, beliefs, barriers, and daughter's vaccine receipt were assessed. Results: The sample consisted of low-income, uninsured, ethnic minority, and immigrant women. Only 29% of daughters initiated the vaccine and 11% received all three doses. No ethnic differences were observed in initiation or completion rates. Ethnic differences were observed in HPV awareness, perceived risk, and other vaccine-related beliefs. The strongest predictor of initiation was vaccine awareness (OR = 12.00). Daughter's age and reporting a younger acceptable age for vaccination were positively associated with initiation. Mothers of unvaccinated girls reported lacking information about the vaccine to make a decision (66%) and not knowing where they could obtain the vaccine (74%). Conclusion: Vaccination rates in this sample were lower than state and national estimates, and were associated with low levels of vaccine awareness. Interventions, including culturally targeted messaging, may be helpful for enhancing HPV–vaccine knowledge, modifying vaccine-related beliefs and increasing uptake. Impact: Our findings provide valuable guidance for developing interventions to address suboptimal HPV vaccination in high-risk groups. Cancer Epidemiol Biomarkers Prev; 20(7); 1463–72. ©2011 AACR.

Previous analysis of a randomized community-based trial of a multi-component intervention to increase colorectal cancer (CRC) screening among Filipino Americans (n = 548) found significantly higher screening rates in the two intervention groups compared to the control group, when using intent-to-treat analysis and self-reported screening as the outcome. This report describes more nuanced findings obtained from alternative approaches to assessing intervention effectiveness to inform future intervention implementation.The effect of the intervention on CRC screening receipt during follow-up was estimated using methods that adjusted for biases due to missing data and self-report and for different combinations of intervention components. Adjustment for self-report used data from a validation substudy. Effectiveness within demographic subgroups was also examined.Analyses accounting for self-report bias and missing data supported the effectiveness of the intervention. The intervention was also broadly effective across the demographic characteristics of the sample. Estimates of the intervention effect were highest among participants whose providers received a letter as part of the intervention.The findings increase confidence that the intervention could be broadly effective at increasing CRC screening in this population. Subgroup analyses and attempts to deconstruct multi-component interventions can provide important information for future intervention development, implementation, and dissemination.

Understanding mediators for behavioral change is important for the optimization of intervention strategies. This report examines mediators of change in the context of a randomized controlled intervention trial (Los Angeles, 2004-2009) that successfully increased colorectal cancer (CRC) screening among Filipino Americans.The intervention, based on the Health Behavior Framework, targeted knowledge/awareness of CRC screening, communication with health care provider, health beliefs, social support and barriers to CRC screening. Health Behavior Framework variables were assessed at baseline and 6-month follow-up (N=432). Variables targeted for change were tested as potential mediators of the primary outcome, self-reported receipt of CRC screening during the follow-up period, which was previously found to have increased significantly among intervention participants.Consistent with the Health Behavior Framework, knowledge/awareness of CRC screening and patient-provider communication mediated receipt of screening. Increase in knowledge/awareness of CRC screening accounted for 13% (95% confidence interval 2%-24%) of the total intervention effect size, while patient-provider communication accounted for 20% (5%-36%). Combined, these two variables accounted for 28% (10%-46%) of the total effect size.Examining the roles of potential mediators in intervention trials may help identify constructs to target in order to enhance the effectiveness of interventions to increase screening.

This secondary data analysis was conducted to evaluate the applicability of the Risk Reappraisal Hypothesis, which has been proposed to explain the influence of performing a health behavior on perceived risk. Data were collected in the context of a randomized trial, which found that an individually tailored, multicomponent intervention was successful in increasing colorectal cancer (CRC) screening among first-degree relatives of CRC cases.The ethnically diverse study sample (N = 841; 29% Latino, 21% African American, 20% Asian) consisted of adult siblings and children (40-80 years) of CRC cases, identified through the California Cancer Registry. Data were collected at baseline and at 6- and 12-month follow-up. Changes in self-reported risk perception (perceived likelihood of developing CRC) were examined over the study period in relation to study condition and screening status.Greater increases in perceived risk were observed among intervention versus control-group participants over the study period, but increases were limited to intervention participants who had not been screened. We also examined trajectories of perceived risk in relation to timing of screening receipt (e.g., before 6 months, 6-12 months, never). Continued upward shifts in risk were observed during the study period among intervention participants not screened during the study. In contrast, participants screened by 6 months displayed a reduction or leveling off in perceived risk between 6- and 12-month follow-up.Results provide support for the applicability of the Risk Reappraisal Hypothesis within a high-risk sample enrolled in a CRC screening promotion trial. Future research is needed to explore the impact of short-term risk reductions on future CRC screening behavior.

Background: Timely diagnostic resolution of abnormal breast findings represents a critical step in efforts to reduce breast cancer morbidity and mortality. Yet, follow-up rates among resource poor populations are not optimal. Efforts to mitigate this disparity are needed. We report results of a randomized trial assessing the effectiveness of a patient support and navigation intervention in increasing timely diagnostic resolution of abnormal breast findings among indigent women. Methods: Women (n = 1,708) diagnosed with a breast abnormality at two public hospitals were randomized to an intervention or control group. The intervention, delivered through telephone, involved one call from a professional health worker and multiple calls from a lay health worker. The outcome, timely diagnostic resolution, defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral, was assessed through medical chart audit. Results: Intent-to-treat analyses revealed no significant effect of the intervention on timely diagnostic resolution. Diagnostic resolution rates were 55% and 56%, respectively, in the intervention and control arms. The significant predictors were method of abnormality identification (odds ratio = 1.50) and location of first scheduled appointment (odds ratio = 0.62). Conclusions: The intervention was not effective in creating change within the County health system. Achieving optimum diagnostic follow-up may require more intensive interventions than the one tested. In addition, system-level rather than patient-level interventions may hold more promise. Impact: There are no randomized trials reported in the literature testing interventions to increase diagnostic follow-up of breast abnormalities. Future research might test patient and system-level interventions that can be sustained beyond the study period. Cancer Epidemiol Biomarkers Prev; 19(8); 1927–36. ©2010 AACR.

Background: Latinos in the United States (US) have disproportionately higher rates of chronic liver disease (CLD). Since 2002, CLD has consistently been the sixth leading cause of overall mortality for Latinos, and the third cause of death among Latino males, ages 55-64. Latino men and women are twice as likely to have CLD and are 1.7 and 1.8 times more likely to die from liver cancer, respectively, than non-Hispanic whites (whites). The frequency of earlier stage liver disease, such as steatohepatitis, is also higher among Latinos (45%), than among whites (33%) or Blacks (24%). In Mexico, cirrhosis and other forms of CLD were the fifth leading cause of general mortality in 2015, and the third among males between the ages of 45 and 65 years. By 2050, an estimated 90% of cases of CLD in Mexico will be attributable to obesity and excessive alcohol consumption, as compared to other populations that have high rates of CLD due to infection with hepatitis B (HBV) or hepatitis C (HCV). Although infection with HBV or HCV and heavy alcohol use are well-known risk factors for CLD and liver cancer, up to 50% of cases do not present these risk factors. Other risk factors for CLD include obesity and diabetes, and the proposed mechanism is through the development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD is found in 80-90% of obese adults, 30-50% of diabetics, and 90% of patients with hyperlipidemia. In the U.S., the prevalence of NAFLD and NASH is highest among Latinos, followed by whites and Blacks. Rates of obesity are also higher among Latinos (42.5%) than whites (34.5%) in the US. In 2012, approximately 69% of men and 73% of women in Mexico were overweight or obese, and these numbers are predicted to rise to 88% and 91%, respectively, by 2050. The objective of this study was to compare the prevalence of risk factors for liver disease/cancer in a representative sample of Mexican-Americans who were born in the U.S. or Mexico, to a sample of adults who reside in Mexico. We hypothesized that Mexican-Americans in the U.S. would be at greater risk for CLD than their counterparts in Mexico. This hypothesis is based on studies suggesting that immigrant Mexican-Americans have better health outcomes than more acculturated, U.S.-born Mexican-Americans. Methods: Data for Mexican-Americans in the U.S. were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, representative, examination survey of the total civilian noninstitutionalized population. The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the U.S. or Mexico, not pregnant or breastfeeding, with medical insurance. The final NHANES sample consisted of 2,097 males and 2,177 females with complete questionnaire and laboratory data. The data in Mexico came from the Heath Worker Cohort Study (HWCS), a longitudinal study of workers and their immediate family members from two large health care institutions in Cuernavaca, Mexico: the Mexican Institute of Social Security (IMSS) and the National Institute of Public Health (INSP). Briefly, the HWCS collects information using physical examinations, self-reported questionnaires, and laboratory tests, which are comparable to those used for the NHANES surveys. From 2004 to 2006 (Wave 1), approximately 9,000 health workers enrolled in the HWCS. During 2011 to 2013 (Wave 2), a total of 1,855 participants were followed up. The final HWCS sample consisted of 3,010 men and 6,475 women 20 years and older who reside and were born in Mexico, with complete questionnaire and laboratory data. The total study sample of 13,798 individuals consisted of 9,485 Mexican subjects who currently reside in Mexico, 2,324 U.S.-born Mexican-Americans who live in the U.S., and 1,989 Mexican-Americans who were born in Mexico and now live in the U.S. The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated ALT was defined as >40 IU/L for men and women; elevated AST was defined as >40 IU/L for men and women), infection with HBV or HCV, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico versus the U.S.) and place of birth (i.e., U.S.-born versus Mexico- born). The HWCS participants represent Mexicans who were born and currently live in Mexico. Individuals from the NHANES sample were further classified by birthplace (U.S.-born versus Mexico-born). The following three groups were compared: (1) HWCS (Mexico resident, Mexico-born), (2) NHANES (U.S. resident, Mexico-born), and (3) NHANES (U.S. resident, U.S.-born). Other independent variables included age, sex, marital status, and education level. Regression analyses were used to investigate liver disease/cancer risk factors. Results: After controlling for age, marital status, and education level, the logistic regression results indicate that Mexico-born Mexican-American males were less likely to have HBV or HCV (OR 0.2, 95% CI 0.1-0.6) but were more likely to have high cholesterol (OR 1.4, 95% CI 1.1-1.8) than their counterparts in Mexico. U.S.-born Mexican-American males were more likely to have metabolic syndrome (OR 1.4, 95% CI 1.1-1.9) and diabetes (OR 3.0, 95% CI 1.9-4.8) than males in Mexico. Mexican-American males were much more likely to be obese, diabetic, have abdominal obesity, or be heavy/binge drinkers than Mexican males. The prevalence ratios and prevalence differences confirm the multivariate analyses findings and may provide more precise estimates of the increased risk of diabetes, obesity, abdominal obesity, and heavy/binge drinking observed among Mexico- and U.S.-born Mexican-American males, as compared to males in Mexico. The probability of having any of the aforementioned risk factors is greater among U.S.-born Mexican-Americans than among their Mexico-born counterparts. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, have abdominal obesity, or be heavy/binge drinkers than Mexican males. The prevalence ratios and prevalence differences mirror the multivariate analyses findings for the aforementioned risk factors, showing a greater risk among U.S.-born as compared to Mexico-born Mexican-Americans. However, the prevalence ratio results indicate that Mexico- and U.S.-born Mexican-American females are significantly less likely to be infected with HBV or HCV than females in Mexico. Conclusions: The results of this binational analysis indicate that Mexican-Americans in the U.S. have more risk factors for liver disease/cancer than their counterparts in Mexico. These results can be used to design and implement more effective health-promotion programs to address the specific factors that put Mexicans at higher risk of developing liver disease/cancer in both countries. This study adds to the relatively scarce literature on binational research, and provides preliminary data for future studies of migrant health in the U.S. and Mexico. Other binational primary data collection projects with representative samples and comparable demographic, socioeconomic, and health status measures are needed to further investigate the growing problem of liver disease/cancer among Mexicans in both countries. Citation Format: Yvonne N. Flores, Zuo-Feng Zhang, Roshan Bastani, Mei Leng, Catherine M. Crespi, Paula Ramirez, Heather A. Stevens, Jorge Salmerón. Risk factors for liver disease/cancer among adults of Mexican descent in the United States and Mexico [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A34.

Little is known about the validity of self-reported completion of diagnostic testing after an abnormal breast cancer screening test. This study assesses the validity of self-reported diagnostic follow-up among 819 low-income, mostly Latina, indigent women with a breast abnormality at two public hospitals in Los Angeles County. Survey responses on receipt of a mammogram, ultrasound, fine needle aspiration, surgical biopsy, or clinical breast exam for diagnostic evaluation of the breast abnormality were compared to medical record data. The authors calculated concordance, Cohen’s κ statistic, and sensitivity and specificity. Kappa values indicated slight agreement for mammogram, ultrasound, and clinical breast exam, and moderate agreement for fine needle aspiration and surgical biopsy. Sensitivity of self-reports was high for all tests; specificity was poor for all tests except surgical biopsy. Self-reports of receipt of diagnostic testing for a breast abnormality among low-income, mostly Latina, indigent women are not accurate when compared to medical records.

Background Korean Americans have one of the lowest screening rates for colorectal cancer. Although physician recommendation is one of the most important predictors of cancer screening across populations, only few Korean American patients receive such a recommendation. Methods We interviewed 14 Korean American physicians in Los Angeles area who primarily serve Korean Americans to explore why they are reluctant to recommend colorectal cancer screening to their Korean patients. Results Physicians identified barriers attributable to themselves (i.e., lack of knowledge, fear of medicolegal liability), their patients (i.e., patient’s unfamiliarity with the concept of screening), and the health care system (i.e., lack of referral network, poor reimbursement). Discussion Our results suggest the need for multi-faceted interventions directed at the physicians, their patients, and the health care system. Further research is needed to validate our results and to assess the extent to which they apply to physicians from other racial/ethnic groups.

Chinese immigrants to North America have substantially higher rates of chronic hepatitis B infection than the general population. One area for strategic development in the field of health education is the design and evaluation of English-as-a-Second language (ESL) curricula. The theoretical perspective of the Health Behavior Framework, results from a community-based survey of Chinese Canadian immigrants with limited English proficiency, and findings from focus groups of ESL instructors as well as Chinese ESL students were used to develop a hepatitis B ESL educational module. This research was conducted in Vancouver, British Columbia. Survey data showed that less than three-fifths of the respondents had been tested for hepatitis B, and documented some important hepatitis B knowledge deficits. Further, only about one-quarter had ever received a physician recommendation for hepatitis B serologic testing. The ESL curriculum aims to both promote hepatitis B testing and improve knowledge, and includes seven different ESL exercises: Warm-up, vocabulary cards, information-gap, video, jigsaw, guided discussion, and problem/advice cards. Our quantitative and qualitative methods for curriculum development could be replicated for other health education topics and in other limited English speaking populations.

BACKGROUND Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests. METHODS Using results from independent cross-sectional telephone surveys with patients aged ≥50 years performed before (2000; n = 498) and after (2003; n = 482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective. RESULTS In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47–2.96]; endoscopy: OR, 2.33 [95% CI, 1.67–3.26]; and any test: OR, 2.86 [95% CI, 2.06–3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60–0.95]; endoscopy: OR, 0.74 [95% CI, 0.60–0.92]; and any test: OR, 0.66 [95% CI, 0.54–0.80]). CONCLUSIONS Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient. Cancer 2008. © 2008 American Cancer Society.

Background. Due to the high prevalence of hepatitis B, Asian Americans have high rates of liver cancer. Screening for hepatitis B leads to monitoring and treatment and prevent further infection through vaccination of contacts.Methods. We reviewed the published literature up to 2006 on hepatitis B awareness, knowledge, and screening among Asian Americans.Results. Many Asian Americans lack knowledge about hepatitis B and have not been screened. Sociodemographics, knowledge, beliefs, and health care variables are associated with screening.Conclusionss. Further research and health policy changes are needed to address the problem of hepatitis B and liver cancer among Asian Americans.

Incomplete or delayed diagnostic resolution of breast abnormalities suspicious for cancer may contribute to poor breast cancer outcomes among ethnic minority women. We examine the effects of socioeconomic characteristics, knowledge, barriers to healthcare, communication, and clinical variables on diagnostic resolution in Latina women with breast abnormalities at two Los Angeles County public hospitals.We analyzed telephone survey data for 714 women. The outcome--timely diagnostic resolution--was based on medical record data and defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral. Predictors of the outcome were obtained from a telephone survey and examined with bivariate and multivariable logistic regression models.Only 60% of women received timely diagnostic resolution; however, the proportion was higher at hospital B (73%) compared with hospital A (56%). In the total sample, the odds of timely diagnostic resolution increased by 8% for every point increase in the scale of satisfaction with how physicians explained the breast abnormality. At hospital B, the odds of timely resolution increased by 57% for every 10-year increase in age.Consistent with findings of other studies, our data indicate low diagnostic resolution among Latina women. Satisfaction with how physicians explained breast abnormalities and the interaction of hospital with age affected timely diagnostic resolution. Future research might focus on developing interventions that offer concrete communication strategies to patients and providers. Health systems must also establish systems that facilitate effective patient-provider communication.

Background: There are no effective breast cancer education programs targeting Samoan women. We tested the effectiveness of a theory-guided, culturally appropriate breast cancer education program (the intervention) designed to increase mammography use among Samoan women. Methods: This community-based participatory cluster-randomized controlled intervention trial used a parallel two-group design. The sample consisted of 776 women aged 42 and older who had not had a mammogram in the preceding 2 years. The primary outcome was self-reported mammogram use between pretest and posttest. Results: Overall, there was no statistically significant intervention effect, although the odds of self-reported mammogram use were higher in the intervention than the control group (odds ratio (OR), 1.26; 95% confidence interval (95% CI), 0.74, 2.14; P = 0.39). Exploratory subgroup analyses found that the intervention was effective only among women who were aware of mammograms but had never previously obtained one (OR, 1.99; 95% CI, 1.03, 3.85; P = 0.04). Low need for social support and lack of endorsement of culture-specific beliefs about breast cancer were associated with mammogram use in this group. In women unaware of mammography at pretest, high perceived susceptibility to breast cancer and endorsement of culture-specific beliefs were associated with mammogram use. For women who had previously obtained a mammogram, lower self-efficacy was associated with mammogram use. Intervention compared with control group women had significantly higher levels of knowledge of risk factors and lower endorsement of culture-specific beliefs at posttest. Conclusions: Results suggest that a multifaceted education intervention may improve mammogram usage for certain subgroups of Samoan women. (Cancer Epidemiol Biomarkers Prev 2007;16(12):2594–604)

Use of colorectal cancer screening is extremely low among Korean Americans. The objective of this study was to gather information on predictors, facilitators, barriers, and intervention preferences with respect to colorectal cancer screening that may inform the development of future interventions for underserved Korean Americans.We developed a questionnaire guided by the Health Behavior Framework and administered it to a convenience sample of 151 Korean Americans aged 40-70 recruited through a community based organization in Los Angeles.In our sample in which 60% of the subjects did not have health insurance, only 17% reported having received a stool blood test within the past year or sigmoidoscopy or colonoscopy within the past 5 years. Having received a physician recommendation was significantly associated and having symptoms of the disease was marginally associated with the outcome variable. Although 64% of respondents reported having a primary care physician, only 29% received a screening recommendation from a physician. Barriers to colorectal cancer screening were lack of health insurance and inability to afford testing, not knowing where to go for testing, language barrier, and fear of being a burden to the family. Intervention preferences included educational seminars, media campaigns, and print materials.Our findings point to the need for a multi-faceted approach that includes educational seminars at community venues, a media campaign, and physician education to increase colorectal cancer screening in this underinsured Korean American population.

ObjectiveTo examine if the use of general preventive services were diminished in a cohort of men following their diagnosis of prostate cancer.Patients and methods16,604 men enrolled in Kaiser Permanente Southern California who were newly diagnosed with prostate cancer from January 1, 2002 through December 31, 2009 were passively followed through electronic medical records to determine the use of preventive services, including screening for colorectal cancer (colonoscopy and/or fecal occult blood tests (FOBT)), tests for diabetes (glucose and hemoglobin A1c) and heart disease (serum cholesterol, high density lipoprotein (HDL) and triglycerides) and vaccinations (influenza and pneumococcal). Preventive service use was compared in the two years prior to and following prostate cancer diagnosis using matched odds ratios (MOR) and 95% confidence intervals (CI) in 2013.ResultsMen were more likely to receive a flu vaccine (MOR: 2.70, 95% CI: 2.52-2.90), lipid tests (MOR: 1.51, 95% CI: 1.42-1.61), diabetes tests (MOR: 2.13, 95% CI: 2.00-2.26) and screening for colorectal cancer (MOR: 1.80, 95% CI: 1.71-1.89) in the two years after prostate cancer diagnosis compared to before. Men with advanced disease at diagnosis were more likely to receive all types of preventive services after diagnosis when compared to men with localized disease.ConclusionsOnce diagnosed with prostate cancer in this setting, no less attention was paid to general preventive care, although there remains room for improvement in pneumococcal vaccination and colon cancer screening rates. The delivery of high-quality continuing care after diagnosis is critical for aging cancer patients.

Background: First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation (UVR) is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. Methods: The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0–17 years; N = 324). Results: Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average-risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn, whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. Conclusions: Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed. Impact: Intervening in high-risk populations may help reduce the burden of melanoma in the United States. Cancer Epidemiol Biomarkers Prev; 24(1); 169–77. ©2015 AACR.

Despite the availability of effective early detection technologies, more than half (61%) of colorectal cancers in the United States and 55% in California are identified at an advanced stage. Data on colorectal cancer patients (N=35,030) diagnosed from 2005 to 2007 were obtained from the California Cancer Registry. Multivariate analyses found a relationship among neighborhood concentration of recent immigrants, neighborhood rates of limited English proficiency, and late-stage colorectal cancer diagnosis. Hispanics living in neighborhoods with a greater percentage of recent immigrants (compared to the lowest percentage) had greater odds (OR 1.57, 95% CI 1.22, 2.02) of late-stage diagnosis whereas Hispanics living in neighborhoods with the highest percentage of limited English proficiency (compared to the lowest percentage) had lower odds (OR .71, 95% CI .51, .99) of late-stage diagnosis. These relationships were not observed for other ethnic groups. Results highlight the complex relationship among race/ethnicity, neighborhood characteristics, and colorectal cancer stage at diagnosis.

BACKGROUND Colorectal cancer (CRC) is the third most common cause of cancer deaths; however, rates of regular screening for this cancer are low. A quality improvement (QI) program to increase CRC screening was developed for use in a managed care health plan. METHODS Thirty-six provider organizations (POs) contracting with the health plan were recruited for a randomized controlled effectiveness trial testing the QI program. The intervention was delivered over a 2-year period, and its effectiveness was assessed by chart review of a random sample of patients from each PO. RESULTS Thirty-two of the 36 POs were evaluable for outcome assessment. During the 2-year intervention period, only 26% of the eligible patients received any CRC screening test. Twenty-nine percent of patients had any CRC screening test within guidelines, with no differences between the intervention or control POs. Significant predictors of having received CRC screening within guidelines were older age (P = 0.0004), receiving care in an integrated medical group (P < 0.0001) and having had a physical examination within the past 2 years (P < 0.0001). CONCLUSIONS A facilitated QI intervention program for CRC screening that focused on the PO did not increase rates of CRC screening. Overall CRC screening rates are low and are in need of improvement. Cancer 2005. © 2005 American Cancer Society.

Background: Few studies have explored health care market structure and colorectal cancer (CRC) screening test use, and little is known whether market factors contribute to racial/ethnic screening disparities. Objective: We investigated whether HMO market level factors, controlling for individual covariates, differentially impact Asian American and Pacific Islander (AAPI) subjects' access to CRC screening compared with white subjects Research Design and Methods: We used random intercept hierarchical models to predict CRC test use. Individual-level survey data was linked to market data by metropolitan statistical areas from InterStudy. Subjects: Insured first-degree relatives, ages 40-80, of a random sample of colorectal cancer cases identified from the California Cancer Registry 515 white subjects and 396 AAPI subjects residing in 36 metropolitan statistical areas (MSAs) Measures: Dependent variables were receipt of (1) annual fecal occult blood test only; (2) sigmoidoscopy in the past 5 years; (3) colonoscopy in the past 10 years; and (4) any of these tests over the recommended time interval. Market characteristics were HMO penetration, HMO competition, and proportion of staff/group/network HMOs. Findings: Market characteristics were as important as individual-level characteristics for AAPI but not for white subjects. Among AAPI subjects, a 10% increase in the percent of group/staff/network model HMO was associated with a reduction in colonoscopy use (28.9% to 20.5%) and in receipt of any of the CRC tests (53.2% to 45 4%). Conclusions: The prevailing organizational structure of a health care market confers a penalty on access to CRC test use among high-risk AAPI subjects but not among high-risk white subjects. Identifying the differential effect of market structure on race/ethnicity can potentially reduce the cancer burden among disadvantaged racial groups.