ASPO Annual Meeting

BIRMINGHAM, ALA. – Serum antibodies induced by a natural human papillomavirus type 16 infection do not appear to protect against acquisition of a subsequent oral HPV 16 infection in men, according to results of the HPV Infection in Men (HIM) study.

That finding is concerning, because about 70% of oropharyngeal cancers in the United States are caused by oral HPV infection. Most are caused by HPV type 16, Christine M. Pierce Campbell, Ph.D. of Moffitt Cancer Center & Research Institute, Tampa and her colleagues reported in a poster at the annual meeting of the American Society of Preventive Oncology.

“HPV antibody status may reflect a man’s history of sexual behavior and partnerships, which may not be sufficiently measured in the risk factor questionnaire. In our study, the proportions of men who have sex with men and men who have sex with women and men who had high levels of antibodies at baseline were substantially greater than the proportion of heterosexual men with high antibody levels,” the researchers wrote. They noted that men with an antibody response may have been exposed to more HPV during their lifetimes, and thus were at greater risk of acquiring new oral HPV.

While naturally induced antibodies may not protect against oral HPV 16 infection, prophylactic HPV vaccination may provide such protection, the investigators said.

Of 1,618 men from the oral HPV 16 subcohort of the prospective natural history study of HPV who were followed for a median of 12.7 months after collection of an initial oral specimen, 17 developed a new incident oral HPV16 infection. Of these 17 men, 11 had low anti-HPV16 serum antibody levels, and 6 had high levels,

Anti-HPV 16 serum antibody levels were not associated with cumulative risk of oral HPV16 infection. During the first year of follow-up, 0.4% of those with low levels vs. 0.8% of those with high levels acquired a new infection. Within 24 months of follow-up, 3.0% of those with low levels vs. 3.5% of those with high levels acquired a new infection.

Those with higher levels were 60% more likely than those with low levels to acquire a new infection (hazard ratio, 1.6), but this finding was not statistically significant, the investigators reported.

Study subjects were men from the United States, Brazil, or Mexico who were aged 18 to 73 years and HIV negative at baseline.

Oral rinse-and-gargle specimens were collected from the men at 6-month intervals for up to 4 years. Low antibody levels were defined as the lowest 3 quartiles of antibody levels in the cohort combined, including those with no detectable antibody, and high levels were defined as the highest quartile.

Because of the rarity of oral HPV, additional study is needed to replicate the findings, they said.

Dr. Campbell was supported in part by a postdoctoral fellowship from the American Cancer Society. The HIM study was supported by a grant from the National Cancer Institute (NCI), by grants and/or other funding to individual authors from Merck, Sharp & Dohme, and from the NCI Intramural Program.

[email protected]

BIRMINGHAM, ALA. – Serum antibodies induced by a natural human papillomavirus type 16 infection do not appear to protect against acquisition of a subsequent oral HPV 16 infection in men, according to results of the HPV Infection in Men (HIM) study.

That finding is concerning, because about 70% of oropharyngeal cancers in the United States are caused by oral HPV infection. Most are caused by HPV type 16, Christine M. Pierce Campbell, Ph.D. of Moffitt Cancer Center & Research Institute, Tampa and her colleagues reported in a poster at the annual meeting of the American Society of Preventive Oncology.

“HPV antibody status may reflect a man’s history of sexual behavior and partnerships, which may not be sufficiently measured in the risk factor questionnaire. In our study, the proportions of men who have sex with men and men who have sex with women and men who had high levels of antibodies at baseline were substantially greater than the proportion of heterosexual men with high antibody levels,” the researchers wrote. They noted that men with an antibody response may have been exposed to more HPV during their lifetimes, and thus were at greater risk of acquiring new oral HPV.

While naturally induced antibodies may not protect against oral HPV 16 infection, prophylactic HPV vaccination may provide such protection, the investigators said.

Of 1,618 men from the oral HPV 16 subcohort of the prospective natural history study of HPV who were followed for a median of 12.7 months after collection of an initial oral specimen, 17 developed a new incident oral HPV16 infection. Of these 17 men, 11 had low anti-HPV16 serum antibody levels, and 6 had high levels,

Anti-HPV 16 serum antibody levels were not associated with cumulative risk of oral HPV16 infection. During the first year of follow-up, 0.4% of those with low levels vs. 0.8% of those with high levels acquired a new infection. Within 24 months of follow-up, 3.0% of those with low levels vs. 3.5% of those with high levels acquired a new infection.

Those with higher levels were 60% more likely than those with low levels to acquire a new infection (hazard ratio, 1.6), but this finding was not statistically significant, the investigators reported.

Study subjects were men from the United States, Brazil, or Mexico who were aged 18 to 73 years and HIV negative at baseline.

Oral rinse-and-gargle specimens were collected from the men at 6-month intervals for up to 4 years. Low antibody levels were defined as the lowest 3 quartiles of antibody levels in the cohort combined, including those with no detectable antibody, and high levels were defined as the highest quartile.

Because of the rarity of oral HPV, additional study is needed to replicate the findings, they said.

Dr. Campbell was supported in part by a postdoctoral fellowship from the American Cancer Society. The HIM study was supported by a grant from the National Cancer Institute (NCI), by grants and/or other funding to individual authors from Merck, Sharp & Dohme, and from the NCI Intramural Program.

[email protected]

BIRMINGHAM, ALA. – Serum antibodies induced by a natural human papillomavirus type 16 infection do not appear to protect against acquisition of a subsequent oral HPV 16 infection in men, according to results of the HPV Infection in Men (HIM) study.

That finding is concerning, because about 70% of oropharyngeal cancers in the United States are caused by oral HPV infection. Most are caused by HPV type 16, Christine M. Pierce Campbell, Ph.D. of Moffitt Cancer Center & Research Institute, Tampa and her colleagues reported in a poster at the annual meeting of the American Society of Preventive Oncology.

“HPV antibody status may reflect a man’s history of sexual behavior and partnerships, which may not be sufficiently measured in the risk factor questionnaire. In our study, the proportions of men who have sex with men and men who have sex with women and men who had high levels of antibodies at baseline were substantially greater than the proportion of heterosexual men with high antibody levels,” the researchers wrote. They noted that men with an antibody response may have been exposed to more HPV during their lifetimes, and thus were at greater risk of acquiring new oral HPV.

While naturally induced antibodies may not protect against oral HPV 16 infection, prophylactic HPV vaccination may provide such protection, the investigators said.

Of 1,618 men from the oral HPV 16 subcohort of the prospective natural history study of HPV who were followed for a median of 12.7 months after collection of an initial oral specimen, 17 developed a new incident oral HPV16 infection. Of these 17 men, 11 had low anti-HPV16 serum antibody levels, and 6 had high levels,

Anti-HPV 16 serum antibody levels were not associated with cumulative risk of oral HPV16 infection. During the first year of follow-up, 0.4% of those with low levels vs. 0.8% of those with high levels acquired a new infection. Within 24 months of follow-up, 3.0% of those with low levels vs. 3.5% of those with high levels acquired a new infection.

Those with higher levels were 60% more likely than those with low levels to acquire a new infection (hazard ratio, 1.6), but this finding was not statistically significant, the investigators reported.

Study subjects were men from the United States, Brazil, or Mexico who were aged 18 to 73 years and HIV negative at baseline.

Oral rinse-and-gargle specimens were collected from the men at 6-month intervals for up to 4 years. Low antibody levels were defined as the lowest 3 quartiles of antibody levels in the cohort combined, including those with no detectable antibody, and high levels were defined as the highest quartile.

Because of the rarity of oral HPV, additional study is needed to replicate the findings, they said.

Dr. Campbell was supported in part by a postdoctoral fellowship from the American Cancer Society. The HIM study was supported by a grant from the National Cancer Institute (NCI), by grants and/or other funding to individual authors from Merck, Sharp & Dohme, and from the NCI Intramural Program.

[email protected]

BIRMINGHAM, ALA. – Minority adolescent girls are less likely than non-Hispanic white girls to receive a physician recommendation for human papillomavirus vaccination, according to a cross-sectional analysis of 2008-2012 national data from the National Immunization Survey-Teen.

Based on the survey of parents or guardians of 77,320 13-17-year old girls, the weighted proportion of non-Hispanic white girls who received a physician recommendation for HPV vaccination in 2008 was 54%, compared with 43%, 40%, and 47% for non-Hispanic black, Hispanic, and non-Hispanic other or multiple race girls, respectively.

National Cancer Institute

The study was reported by Dr. Mahbubur Rahman and colleagues from The University of Texas Medical Branch at Galveston in a poster at the annual meeting of the American Society of Preventive Oncology.

A similar pattern was seen in the remaining years of the study. The weighted proportions for white vs. non-Hispanic black, Hispanic, and non-Hispanic other or multiple race girls were 60% vs. 50%, 51%, and 56% in 2009, 59% vs. 46%, 48%, and 56% in 2010, 63% vs. 52%, 51%, and 57% in 2011, and 70% vs. 63%, 56%, and 60% in 2012, the investigators said.

After adjustment for demographic characteristics, a separate weighted analysis for each year of data showed the differences between the non-Hispanic white girls and the other groups were statistically significant for all 5 years. The differences between the non-Hispanic black and Hispanic girls were not statistically significant.

The weighted adjusted odds ratio of receiving a physician recommendation for HPV vaccination among minority girls aged 13-17 varied from 0.81 to 0.87, between 2008 and 2012.

The findings confirm those from a 2009 study showing that white women were more likely than minority women to receive a recommendation for HPV vaccination in their adolescent daughters, and confirms that the findings is persistent, rather than a transient phenomenon.

This is notable, because according to 2013 data, HPV vaccine uptake among girls aged 13 to 17 years is lower than the Healthy People 2020 target of 80% for the 3-dose series among those aged 13 to 15 years. It is also below the level needed for herd immunity (75% to 94%), the investigators said, noting that studies show a strong association between provider recommendation and vaccine uptake.

In fact, provider recommendation is the best predictor of vaccine uptake; adolescent girls who receive a provider recommendation are five times more likely to initiate the HPV vaccine series than are those without a recommendation, they said.

“Reasons for racial disparity in receiving a physician recommendation need to be identified and interventions developed to achieve the targeted HPV vaccine uptake among U.S. adolescent girls irrespective of race/ethnicity,” they concluded.

The authors reported having no disclosures.

[email protected]

BIRMINGHAM, ALA. – Minority adolescent girls are less likely than non-Hispanic white girls to receive a physician recommendation for human papillomavirus vaccination, according to a cross-sectional analysis of 2008-2012 national data from the National Immunization Survey-Teen.

Based on the survey of parents or guardians of 77,320 13-17-year old girls, the weighted proportion of non-Hispanic white girls who received a physician recommendation for HPV vaccination in 2008 was 54%, compared with 43%, 40%, and 47% for non-Hispanic black, Hispanic, and non-Hispanic other or multiple race girls, respectively.

National Cancer Institute

The study was reported by Dr. Mahbubur Rahman and colleagues from The University of Texas Medical Branch at Galveston in a poster at the annual meeting of the American Society of Preventive Oncology.

A similar pattern was seen in the remaining years of the study. The weighted proportions for white vs. non-Hispanic black, Hispanic, and non-Hispanic other or multiple race girls were 60% vs. 50%, 51%, and 56% in 2009, 59% vs. 46%, 48%, and 56% in 2010, 63% vs. 52%, 51%, and 57% in 2011, and 70% vs. 63%, 56%, and 60% in 2012, the investigators said.

After adjustment for demographic characteristics, a separate weighted analysis for each year of data showed the differences between the non-Hispanic white girls and the other groups were statistically significant for all 5 years. The differences between the non-Hispanic black and Hispanic girls were not statistically significant.

The weighted adjusted odds ratio of receiving a physician recommendation for HPV vaccination among minority girls aged 13-17 varied from 0.81 to 0.87, between 2008 and 2012.

The findings confirm those from a 2009 study showing that white women were more likely than minority women to receive a recommendation for HPV vaccination in their adolescent daughters, and confirms that the findings is persistent, rather than a transient phenomenon.

This is notable, because according to 2013 data, HPV vaccine uptake among girls aged 13 to 17 years is lower than the Healthy People 2020 target of 80% for the 3-dose series among those aged 13 to 15 years. It is also below the level needed for herd immunity (75% to 94%), the investigators said, noting that studies show a strong association between provider recommendation and vaccine uptake.

In fact, provider recommendation is the best predictor of vaccine uptake; adolescent girls who receive a provider recommendation are five times more likely to initiate the HPV vaccine series than are those without a recommendation, they said.

“Reasons for racial disparity in receiving a physician recommendation need to be identified and interventions developed to achieve the targeted HPV vaccine uptake among U.S. adolescent girls irrespective of race/ethnicity,” they concluded.

The authors reported having no disclosures.

[email protected]

BIRMINGHAM, ALA. – Minority adolescent girls are less likely than non-Hispanic white girls to receive a physician recommendation for human papillomavirus vaccination, according to a cross-sectional analysis of 2008-2012 national data from the National Immunization Survey-Teen.

Based on the survey of parents or guardians of 77,320 13-17-year old girls, the weighted proportion of non-Hispanic white girls who received a physician recommendation for HPV vaccination in 2008 was 54%, compared with 43%, 40%, and 47% for non-Hispanic black, Hispanic, and non-Hispanic other or multiple race girls, respectively.

National Cancer Institute

The study was reported by Dr. Mahbubur Rahman and colleagues from The University of Texas Medical Branch at Galveston in a poster at the annual meeting of the American Society of Preventive Oncology.

A similar pattern was seen in the remaining years of the study. The weighted proportions for white vs. non-Hispanic black, Hispanic, and non-Hispanic other or multiple race girls were 60% vs. 50%, 51%, and 56% in 2009, 59% vs. 46%, 48%, and 56% in 2010, 63% vs. 52%, 51%, and 57% in 2011, and 70% vs. 63%, 56%, and 60% in 2012, the investigators said.

After adjustment for demographic characteristics, a separate weighted analysis for each year of data showed the differences between the non-Hispanic white girls and the other groups were statistically significant for all 5 years. The differences between the non-Hispanic black and Hispanic girls were not statistically significant.

The weighted adjusted odds ratio of receiving a physician recommendation for HPV vaccination among minority girls aged 13-17 varied from 0.81 to 0.87, between 2008 and 2012.

The findings confirm those from a 2009 study showing that white women were more likely than minority women to receive a recommendation for HPV vaccination in their adolescent daughters, and confirms that the findings is persistent, rather than a transient phenomenon.

This is notable, because according to 2013 data, HPV vaccine uptake among girls aged 13 to 17 years is lower than the Healthy People 2020 target of 80% for the 3-dose series among those aged 13 to 15 years. It is also below the level needed for herd immunity (75% to 94%), the investigators said, noting that studies show a strong association between provider recommendation and vaccine uptake.

In fact, provider recommendation is the best predictor of vaccine uptake; adolescent girls who receive a provider recommendation are five times more likely to initiate the HPV vaccine series than are those without a recommendation, they said.

“Reasons for racial disparity in receiving a physician recommendation need to be identified and interventions developed to achieve the targeted HPV vaccine uptake among U.S. adolescent girls irrespective of race/ethnicity,” they concluded.

The authors reported having no disclosures.

[email protected]

BIRMINGHAM, ALA. – Children with birth defects have been shown to have an increased risk of developing cancer, and preliminary findings from a large record-linkage study not only confirm and better define the risk, but also demonstrate the value of such studies for identifying new risk factors for childhood cancer, according to Philip J. Lupo, Ph.D.

Because birth defects and childhood cancers are relatively rare, large-scale linkages of state- and federally-funded disease registries may be helpful to identify new childhood cancer predisposition syndromes, Dr. Lupo of Baylor College of Medicine, Houston, and his colleagues reported in a poster at the annual meeting of the American Society of Preventive Oncology.

“Epidemiological investigations have indicated that cancer risk is greater among those with major malformations such as spina bifida, as well as among those with relatively minor malformations, such as rib anomalies,” he said, noting that well-established birth defect-childhood cancer associations include Down syndrome and leukemia and Beckwith-Wiedemann syndrome and Wilms tumor.

Recent record-linkage studies have pointed to a number of previously unidentified associations, but these patterns require confirmation in larger studies; much more information is needed with respect to less common birth defects and childhood cancers. Additionally, understanding why some of these conditions overlap is critical for prevention efforts, he said.

Thus, he and his colleagues are planning to assemble a large population-based birth cohort to identify novel cancer predisposition syndromes, and enroll families where children have both a birth defect and cancer to better understand the molecular underpinnings of these conditions.

The project, titled the Genetic overlap Between Anomalies and Cancer in Kids (GOBACK) Study, involves registry linkages in several states, which together represent more than 10 million births.

In a preliminary assessment using data from the Michigan Department of Community Health for more than 2.5 million births, the investigators found increased risks of cancer among children with several specific birth defects. For instance, children with cardiac defects were twice as likely to develop cancer as were those without cardiac defects. Additionally, for those born with any birth defect, the risk of specific cancers was also elevated. For example, those with any birth defect were twice as likely as those without birth defects to develop rhabdomyosarcoma.

The findings are consistent with previous studies, and thus reinforce the utility of record linkages between population-based registries for epidemiologic assessments of these conditions, Dr. Lupo said, noting that identifying specific associations will allow for molecular studies to determine whether common developmental pathways underlie the etiology of birth defects and childhood cancer.

Dr. Lupo reported having no disclosures.

[email protected]

BIRMINGHAM, ALA. – Children with birth defects have been shown to have an increased risk of developing cancer, and preliminary findings from a large record-linkage study not only confirm and better define the risk, but also demonstrate the value of such studies for identifying new risk factors for childhood cancer, according to Philip J. Lupo, Ph.D.

Because birth defects and childhood cancers are relatively rare, large-scale linkages of state- and federally-funded disease registries may be helpful to identify new childhood cancer predisposition syndromes, Dr. Lupo of Baylor College of Medicine, Houston, and his colleagues reported in a poster at the annual meeting of the American Society of Preventive Oncology.

“Epidemiological investigations have indicated that cancer risk is greater among those with major malformations such as spina bifida, as well as among those with relatively minor malformations, such as rib anomalies,” he said, noting that well-established birth defect-childhood cancer associations include Down syndrome and leukemia and Beckwith-Wiedemann syndrome and Wilms tumor.

Recent record-linkage studies have pointed to a number of previously unidentified associations, but these patterns require confirmation in larger studies; much more information is needed with respect to less common birth defects and childhood cancers. Additionally, understanding why some of these conditions overlap is critical for prevention efforts, he said.

Thus, he and his colleagues are planning to assemble a large population-based birth cohort to identify novel cancer predisposition syndromes, and enroll families where children have both a birth defect and cancer to better understand the molecular underpinnings of these conditions.

The project, titled the Genetic overlap Between Anomalies and Cancer in Kids (GOBACK) Study, involves registry linkages in several states, which together represent more than 10 million births.

In a preliminary assessment using data from the Michigan Department of Community Health for more than 2.5 million births, the investigators found increased risks of cancer among children with several specific birth defects. For instance, children with cardiac defects were twice as likely to develop cancer as were those without cardiac defects. Additionally, for those born with any birth defect, the risk of specific cancers was also elevated. For example, those with any birth defect were twice as likely as those without birth defects to develop rhabdomyosarcoma.

The findings are consistent with previous studies, and thus reinforce the utility of record linkages between population-based registries for epidemiologic assessments of these conditions, Dr. Lupo said, noting that identifying specific associations will allow for molecular studies to determine whether common developmental pathways underlie the etiology of birth defects and childhood cancer.

Dr. Lupo reported having no disclosures.

[email protected]

BIRMINGHAM, ALA. – Children with birth defects have been shown to have an increased risk of developing cancer, and preliminary findings from a large record-linkage study not only confirm and better define the risk, but also demonstrate the value of such studies for identifying new risk factors for childhood cancer, according to Philip J. Lupo, Ph.D.

Because birth defects and childhood cancers are relatively rare, large-scale linkages of state- and federally-funded disease registries may be helpful to identify new childhood cancer predisposition syndromes, Dr. Lupo of Baylor College of Medicine, Houston, and his colleagues reported in a poster at the annual meeting of the American Society of Preventive Oncology.

“Epidemiological investigations have indicated that cancer risk is greater among those with major malformations such as spina bifida, as well as among those with relatively minor malformations, such as rib anomalies,” he said, noting that well-established birth defect-childhood cancer associations include Down syndrome and leukemia and Beckwith-Wiedemann syndrome and Wilms tumor.

Recent record-linkage studies have pointed to a number of previously unidentified associations, but these patterns require confirmation in larger studies; much more information is needed with respect to less common birth defects and childhood cancers. Additionally, understanding why some of these conditions overlap is critical for prevention efforts, he said.

Thus, he and his colleagues are planning to assemble a large population-based birth cohort to identify novel cancer predisposition syndromes, and enroll families where children have both a birth defect and cancer to better understand the molecular underpinnings of these conditions.

The project, titled the Genetic overlap Between Anomalies and Cancer in Kids (GOBACK) Study, involves registry linkages in several states, which together represent more than 10 million births.

In a preliminary assessment using data from the Michigan Department of Community Health for more than 2.5 million births, the investigators found increased risks of cancer among children with several specific birth defects. For instance, children with cardiac defects were twice as likely to develop cancer as were those without cardiac defects. Additionally, for those born with any birth defect, the risk of specific cancers was also elevated. For example, those with any birth defect were twice as likely as those without birth defects to develop rhabdomyosarcoma.

The findings are consistent with previous studies, and thus reinforce the utility of record linkages between population-based registries for epidemiologic assessments of these conditions, Dr. Lupo said, noting that identifying specific associations will allow for molecular studies to determine whether common developmental pathways underlie the etiology of birth defects and childhood cancer.

Dr. Lupo reported having no disclosures.

[email protected]

BIRMINGHAM, ALA. – The perception that one’s physician had recommended contralateral prophylactic mastectomy was a particularly important factor in the decision to undergo the procedure among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer in a prospective study.

Of 90 BRCA noncarriers with newly diagnosed breast cancer, a “sizable minority” (24.4%) chose to undergo contralateral prophylactic mastectomy (CPM) after learning their mutation status, Jada G. Hamilton, Ph.D., reported at the annual meeting of the American Society of Preventive Oncology.

By comparison, 88% of eight BRCA1/2 carriers who participated in the study chose to undergo CPM, and neither of two women with a BRCA1/2 variant of undetermined significance chose to undergo CPM.

On multivariate analysis, the perception that one’s physician had recommended CPM was most strongly associated with the decision to undergo the procedure (odds ratio, 11.1), said Dr. Hamilton of Memorial Sloan-Kettering Cancer Center, New York.

Other factors associated with the decision were a perception of greater risk for contralateral breast cancer (OR, 6.46) and a perception of greater pros of CPM (OR, 1.37), she said, noting that those who indicated they would feel good about having CPM and those who indicated they might feel regret if they didn’t have CPM were most likely to elect CPM.

Age, Ashkenazi Jewish ethnicity, breast cancer–related distress, perceived cons of CPM (such as disfigurement and concerns regarding a negative impact on one’s sex life), and decisional conflict regarding CPM were not significantly associated with the decision.

Presurgical genetic testing provides valuable information to women with newly diagnosed breast cancer as they begin to make decisions about treatment, Dr. Hamilton said. Although BRCA1/2 mutation noncarriers have a low (3%-10%) risk, compared with carriers (27%-37%), studies suggest that about 18% nevertheless choose to undergo CPM.

The psychosocial factors that may affect the decision are not well understood, Dr. Hamilton said.

For the current analysis, participants who were part of a larger prospective study on presurgical BRCA1/2 testing completed a questionnaire, and the frequency and psychosocial correlates of the decision to undergo a CPM were assessed. The participants were adult women with a median age of 43 years (range of 29-59 years).

The findings raise interesting questions for future work, Dr. Hamilton said.

“I think it’s really critical for future studies to dig in to what’s happening in terms of physician-patient communication around CPM,” she said, noting that it will be important to explore how such communication interacts with a woman’s past experiences, emotions, and beliefs to shape her cancer prevention decisions.

Further, the women who undergo CPM should be followed to assess their long-term outcomes with respect to factors such as quality of life, satisfaction, and decisional regret, she concluded.

The decision to undergo CPM and the effects of physician-patient communication on that decision were also addressed in another study presented at the meeting.

In that study – a mixed methods pilot study looking mainly at factors affecting informed decision making in women who had ductal carcinoma in situ (DCIS) or who were considered to be at increased risk of invasive breast cancer risk because of a diagnosis of lobular carcinoma in situ (LCIS), BRCA positivity, or 20% or greater calculated lifetime risk – anxiety about cancer recurrence was the top reason for pursuing CPM.

Despite a lack of survival benefit, an increasing number of women with DCIS are undergoing CPM, but little is known about the decision-making process, said Jessica Valente of Emory University, Atlanta.

She and her colleagues sought to identify factors impacting risk comprehension and decision making. Of 68 women with DCIS or who were at high risk for development of invasive breast cancer, 33 considered CPM and 11 underwent the procedure.

The choice to undergo CPM was significantly associated with plastic surgery consultation, increased 10-year breast cancer risk, genetic counseling, genetic testing, and higher income, she said.

The study also highlighted a lack of health literacy and understanding of related terminology.

Most participants (nearly 84%) stated that DCIS qualified as breast cancer, but only about 40% correctly defined DCIS, Ms. Valente said.

When asked what they would recommend as a treatment strategy for a friend with DCIS, 35% thought surgery would be best. A similar percentage would recommend surgery for LCIS.

“When we looked at ductal hyperplasia, fewer people thought that that qualified as cancer, and they were more likely to recommend observation,” she said.

Further, when asked to interpret the phrase “indolent lesion of epithelial origin,” which is a phrase that has been promoted as a replacement for “DCIS” in light of concerns that women are increasingly electing CPM for DCIS because of fear of the word “carcinoma” despite a 99% survival rate, only 28% of patients believed it referred to cancer.

Observation was one of the highly recommended interventions for “indolent lesion of epithelial origin,” followed by biopsy, she said, noting that only 13% recommended surgery when this phrase was used.

“Interestingly, 7.4% said an oral or topical medication [should be used for “indolent lesion of epithelial origin]” – a finding likely explained by the fact that some women interpreted the word “lesion” to mean a wound or sore on the skin, she said.

Additionally, few women were able to define contralateral prophylactic mastectomy.

Overall, despite the study population being very well educated and from a higher socioeconomic status, they had low scores for understanding terminology (8.21 out of 20), Ms. Valente noted.

The findings demonstrate that decision making in the context of DCIS remains complex and underscore the importance of recognizing patients’ knowledge of risk communication and terminology for supporting shared and informed surgical decision making, she said.

The findings also demonstrate that while fewer women felt that surgery was appropriate when the term “indolent lesion of epithelial origin” was used instead of “DCIS,” the proposed new terminology doesn’t necessarily provide the desired clarity, she noted.

“They still came up with such a broad range of interpretations that we really might be introducing a new set of conflicts and confusion when we think about changing to that terminology when we talk to patients,” she concluded.

Dr. Hamilton and Ms. Valente each reported having no disclosures.

BIRMINGHAM, ALA. – The perception that one’s physician had recommended contralateral prophylactic mastectomy was a particularly important factor in the decision to undergo the procedure among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer in a prospective study.

Of 90 BRCA noncarriers with newly diagnosed breast cancer, a “sizable minority” (24.4%) chose to undergo contralateral prophylactic mastectomy (CPM) after learning their mutation status, Jada G. Hamilton, Ph.D., reported at the annual meeting of the American Society of Preventive Oncology.

By comparison, 88% of eight BRCA1/2 carriers who participated in the study chose to undergo CPM, and neither of two women with a BRCA1/2 variant of undetermined significance chose to undergo CPM.

On multivariate analysis, the perception that one’s physician had recommended CPM was most strongly associated with the decision to undergo the procedure (odds ratio, 11.1), said Dr. Hamilton of Memorial Sloan-Kettering Cancer Center, New York.

Other factors associated with the decision were a perception of greater risk for contralateral breast cancer (OR, 6.46) and a perception of greater pros of CPM (OR, 1.37), she said, noting that those who indicated they would feel good about having CPM and those who indicated they might feel regret if they didn’t have CPM were most likely to elect CPM.

Age, Ashkenazi Jewish ethnicity, breast cancer–related distress, perceived cons of CPM (such as disfigurement and concerns regarding a negative impact on one’s sex life), and decisional conflict regarding CPM were not significantly associated with the decision.

Presurgical genetic testing provides valuable information to women with newly diagnosed breast cancer as they begin to make decisions about treatment, Dr. Hamilton said. Although BRCA1/2 mutation noncarriers have a low (3%-10%) risk, compared with carriers (27%-37%), studies suggest that about 18% nevertheless choose to undergo CPM.

The psychosocial factors that may affect the decision are not well understood, Dr. Hamilton said.

For the current analysis, participants who were part of a larger prospective study on presurgical BRCA1/2 testing completed a questionnaire, and the frequency and psychosocial correlates of the decision to undergo a CPM were assessed. The participants were adult women with a median age of 43 years (range of 29-59 years).

The findings raise interesting questions for future work, Dr. Hamilton said.

“I think it’s really critical for future studies to dig in to what’s happening in terms of physician-patient communication around CPM,” she said, noting that it will be important to explore how such communication interacts with a woman’s past experiences, emotions, and beliefs to shape her cancer prevention decisions.

Further, the women who undergo CPM should be followed to assess their long-term outcomes with respect to factors such as quality of life, satisfaction, and decisional regret, she concluded.

The decision to undergo CPM and the effects of physician-patient communication on that decision were also addressed in another study presented at the meeting.

In that study – a mixed methods pilot study looking mainly at factors affecting informed decision making in women who had ductal carcinoma in situ (DCIS) or who were considered to be at increased risk of invasive breast cancer risk because of a diagnosis of lobular carcinoma in situ (LCIS), BRCA positivity, or 20% or greater calculated lifetime risk – anxiety about cancer recurrence was the top reason for pursuing CPM.

Despite a lack of survival benefit, an increasing number of women with DCIS are undergoing CPM, but little is known about the decision-making process, said Jessica Valente of Emory University, Atlanta.

She and her colleagues sought to identify factors impacting risk comprehension and decision making. Of 68 women with DCIS or who were at high risk for development of invasive breast cancer, 33 considered CPM and 11 underwent the procedure.

The choice to undergo CPM was significantly associated with plastic surgery consultation, increased 10-year breast cancer risk, genetic counseling, genetic testing, and higher income, she said.

The study also highlighted a lack of health literacy and understanding of related terminology.

Most participants (nearly 84%) stated that DCIS qualified as breast cancer, but only about 40% correctly defined DCIS, Ms. Valente said.

When asked what they would recommend as a treatment strategy for a friend with DCIS, 35% thought surgery would be best. A similar percentage would recommend surgery for LCIS.

“When we looked at ductal hyperplasia, fewer people thought that that qualified as cancer, and they were more likely to recommend observation,” she said.

Further, when asked to interpret the phrase “indolent lesion of epithelial origin,” which is a phrase that has been promoted as a replacement for “DCIS” in light of concerns that women are increasingly electing CPM for DCIS because of fear of the word “carcinoma” despite a 99% survival rate, only 28% of patients believed it referred to cancer.

Observation was one of the highly recommended interventions for “indolent lesion of epithelial origin,” followed by biopsy, she said, noting that only 13% recommended surgery when this phrase was used.

“Interestingly, 7.4% said an oral or topical medication [should be used for “indolent lesion of epithelial origin]” – a finding likely explained by the fact that some women interpreted the word “lesion” to mean a wound or sore on the skin, she said.

Additionally, few women were able to define contralateral prophylactic mastectomy.

Overall, despite the study population being very well educated and from a higher socioeconomic status, they had low scores for understanding terminology (8.21 out of 20), Ms. Valente noted.

The findings demonstrate that decision making in the context of DCIS remains complex and underscore the importance of recognizing patients’ knowledge of risk communication and terminology for supporting shared and informed surgical decision making, she said.

The findings also demonstrate that while fewer women felt that surgery was appropriate when the term “indolent lesion of epithelial origin” was used instead of “DCIS,” the proposed new terminology doesn’t necessarily provide the desired clarity, she noted.

“They still came up with such a broad range of interpretations that we really might be introducing a new set of conflicts and confusion when we think about changing to that terminology when we talk to patients,” she concluded.

Dr. Hamilton and Ms. Valente each reported having no disclosures.

BIRMINGHAM, ALA. – The perception that one’s physician had recommended contralateral prophylactic mastectomy was a particularly important factor in the decision to undergo the procedure among BRCA1/2 mutation noncarriers with newly diagnosed breast cancer in a prospective study.

Of 90 BRCA noncarriers with newly diagnosed breast cancer, a “sizable minority” (24.4%) chose to undergo contralateral prophylactic mastectomy (CPM) after learning their mutation status, Jada G. Hamilton, Ph.D., reported at the annual meeting of the American Society of Preventive Oncology.

By comparison, 88% of eight BRCA1/2 carriers who participated in the study chose to undergo CPM, and neither of two women with a BRCA1/2 variant of undetermined significance chose to undergo CPM.

On multivariate analysis, the perception that one’s physician had recommended CPM was most strongly associated with the decision to undergo the procedure (odds ratio, 11.1), said Dr. Hamilton of Memorial Sloan-Kettering Cancer Center, New York.

Other factors associated with the decision were a perception of greater risk for contralateral breast cancer (OR, 6.46) and a perception of greater pros of CPM (OR, 1.37), she said, noting that those who indicated they would feel good about having CPM and those who indicated they might feel regret if they didn’t have CPM were most likely to elect CPM.

Age, Ashkenazi Jewish ethnicity, breast cancer–related distress, perceived cons of CPM (such as disfigurement and concerns regarding a negative impact on one’s sex life), and decisional conflict regarding CPM were not significantly associated with the decision.

Presurgical genetic testing provides valuable information to women with newly diagnosed breast cancer as they begin to make decisions about treatment, Dr. Hamilton said. Although BRCA1/2 mutation noncarriers have a low (3%-10%) risk, compared with carriers (27%-37%), studies suggest that about 18% nevertheless choose to undergo CPM.

The psychosocial factors that may affect the decision are not well understood, Dr. Hamilton said.

For the current analysis, participants who were part of a larger prospective study on presurgical BRCA1/2 testing completed a questionnaire, and the frequency and psychosocial correlates of the decision to undergo a CPM were assessed. The participants were adult women with a median age of 43 years (range of 29-59 years).

The findings raise interesting questions for future work, Dr. Hamilton said.

“I think it’s really critical for future studies to dig in to what’s happening in terms of physician-patient communication around CPM,” she said, noting that it will be important to explore how such communication interacts with a woman’s past experiences, emotions, and beliefs to shape her cancer prevention decisions.

Further, the women who undergo CPM should be followed to assess their long-term outcomes with respect to factors such as quality of life, satisfaction, and decisional regret, she concluded.

The decision to undergo CPM and the effects of physician-patient communication on that decision were also addressed in another study presented at the meeting.

In that study – a mixed methods pilot study looking mainly at factors affecting informed decision making in women who had ductal carcinoma in situ (DCIS) or who were considered to be at increased risk of invasive breast cancer risk because of a diagnosis of lobular carcinoma in situ (LCIS), BRCA positivity, or 20% or greater calculated lifetime risk – anxiety about cancer recurrence was the top reason for pursuing CPM.

Despite a lack of survival benefit, an increasing number of women with DCIS are undergoing CPM, but little is known about the decision-making process, said Jessica Valente of Emory University, Atlanta.

She and her colleagues sought to identify factors impacting risk comprehension and decision making. Of 68 women with DCIS or who were at high risk for development of invasive breast cancer, 33 considered CPM and 11 underwent the procedure.

The choice to undergo CPM was significantly associated with plastic surgery consultation, increased 10-year breast cancer risk, genetic counseling, genetic testing, and higher income, she said.

The study also highlighted a lack of health literacy and understanding of related terminology.

Most participants (nearly 84%) stated that DCIS qualified as breast cancer, but only about 40% correctly defined DCIS, Ms. Valente said.

When asked what they would recommend as a treatment strategy for a friend with DCIS, 35% thought surgery would be best. A similar percentage would recommend surgery for LCIS.

“When we looked at ductal hyperplasia, fewer people thought that that qualified as cancer, and they were more likely to recommend observation,” she said.

Further, when asked to interpret the phrase “indolent lesion of epithelial origin,” which is a phrase that has been promoted as a replacement for “DCIS” in light of concerns that women are increasingly electing CPM for DCIS because of fear of the word “carcinoma” despite a 99% survival rate, only 28% of patients believed it referred to cancer.

Observation was one of the highly recommended interventions for “indolent lesion of epithelial origin,” followed by biopsy, she said, noting that only 13% recommended surgery when this phrase was used.

“Interestingly, 7.4% said an oral or topical medication [should be used for “indolent lesion of epithelial origin]” – a finding likely explained by the fact that some women interpreted the word “lesion” to mean a wound or sore on the skin, she said.

Additionally, few women were able to define contralateral prophylactic mastectomy.

Overall, despite the study population being very well educated and from a higher socioeconomic status, they had low scores for understanding terminology (8.21 out of 20), Ms. Valente noted.

The findings demonstrate that decision making in the context of DCIS remains complex and underscore the importance of recognizing patients’ knowledge of risk communication and terminology for supporting shared and informed surgical decision making, she said.

The findings also demonstrate that while fewer women felt that surgery was appropriate when the term “indolent lesion of epithelial origin” was used instead of “DCIS,” the proposed new terminology doesn’t necessarily provide the desired clarity, she noted.

“They still came up with such a broad range of interpretations that we really might be introducing a new set of conflicts and confusion when we think about changing to that terminology when we talk to patients,” she concluded.

Dr. Hamilton and Ms. Valente each reported having no disclosures.

BIRMINGHAM, ALA. – Neither depression nor antidepressant use are associated with an increased risk of breast cancer among participants in the Nurses’ Health Study, according to an analysis of data from 67,120 women enrolled in the ongoing prospective cohort study.

Of the women included in the analysis, 2,904 had confirmed breast cancer as of the end of December 2012, including 2,333 with invasive disease. After adjusting for age, body mass index, and menopausal status, no statistically significant associations were seen between invasive or in situ breast cancer and depression or antidepressant use, Katherine W. Reeves, Ph.D. reported at the annual meeting of the American Society of Preventive Oncology.

The point estimates for the odds ratios were all below 1 for in situ disease, indicating a potential protective effect of depression, Dr. Reeves said.

“These were not statistically significant, so I would caution against overinterpreting the results, but it is kind of curious,” she said, noting that the finding may indicate that depressed women are less likely than nondepressed women are to have a mammogram – and thus are less likely to have the opportunity to be diagnosed with in situ disease.

When depression and antidepressant use were included together in the same model, they remained unassociated with breast cancer risk (odds ratio, 0.87), said Dr. Reeves of the University of Massachusetts Amherst.

Study subjects were an average age of 66 years, 8.7% were clinically depressed, and 9.7% used antidepressants. Data on depression and antidepressant use among Nurses’ Health Study participants were collected simultaneously beginning in 2000.

Depression and antidepressant use were self-reported, and depressive symptoms were confirmed using the five-item Mental Health Inventory.

The findings are encouraging; depression and antidepressant use are common and both have been hypothesized to increase breast cancer risk. Some prior studies have found a link between either depression or antidepressant use and breast cancer, and others have not – but most have had important limitations, including retrospective design and inclusion of major depression only, among others, she said.

“To me, though, the most important limitation is that previous studies have not evaluated depression and antidepressant use together,” Dr. Reeves said.

In the current study, which did consider both, no evidence was seen to suggest that depression or antidepressant use affects breast cancer risk.

“It’s typically very unexciting to have to report null results, but in this case, I think this is excellent news and really the best we could have hoped for,” she said, adding that although they are preliminary, the findings should be “very reassuring for the millions of women with depression and/or those using antidepressants.”

“Depression is a very serious medical condition. It deserves to be treated, and it’s nice that these women can take the antidepressants, which so effectively treat this condition without worry that they’re doing something that would adversely affect their breast cancer risk in the future,” she concluded, noting that more sophisticated analyses of the data are planned to consider additional variables, including treatment duration. The analyses will also be repeated in the Nurses’ Health Study II cohort, which is a younger cohort with a higher incidence of premenopausal breast cancer and a greater prevalence of both depression and antidepressant use.

BIRMINGHAM, ALA. – Neither depression nor antidepressant use are associated with an increased risk of breast cancer among participants in the Nurses’ Health Study, according to an analysis of data from 67,120 women enrolled in the ongoing prospective cohort study.

Of the women included in the analysis, 2,904 had confirmed breast cancer as of the end of December 2012, including 2,333 with invasive disease. After adjusting for age, body mass index, and menopausal status, no statistically significant associations were seen between invasive or in situ breast cancer and depression or antidepressant use, Katherine W. Reeves, Ph.D. reported at the annual meeting of the American Society of Preventive Oncology.

The point estimates for the odds ratios were all below 1 for in situ disease, indicating a potential protective effect of depression, Dr. Reeves said.

“These were not statistically significant, so I would caution against overinterpreting the results, but it is kind of curious,” she said, noting that the finding may indicate that depressed women are less likely than nondepressed women are to have a mammogram – and thus are less likely to have the opportunity to be diagnosed with in situ disease.

When depression and antidepressant use were included together in the same model, they remained unassociated with breast cancer risk (odds ratio, 0.87), said Dr. Reeves of the University of Massachusetts Amherst.

Study subjects were an average age of 66 years, 8.7% were clinically depressed, and 9.7% used antidepressants. Data on depression and antidepressant use among Nurses’ Health Study participants were collected simultaneously beginning in 2000.

Depression and antidepressant use were self-reported, and depressive symptoms were confirmed using the five-item Mental Health Inventory.

The findings are encouraging; depression and antidepressant use are common and both have been hypothesized to increase breast cancer risk. Some prior studies have found a link between either depression or antidepressant use and breast cancer, and others have not – but most have had important limitations, including retrospective design and inclusion of major depression only, among others, she said.

“To me, though, the most important limitation is that previous studies have not evaluated depression and antidepressant use together,” Dr. Reeves said.

In the current study, which did consider both, no evidence was seen to suggest that depression or antidepressant use affects breast cancer risk.

“It’s typically very unexciting to have to report null results, but in this case, I think this is excellent news and really the best we could have hoped for,” she said, adding that although they are preliminary, the findings should be “very reassuring for the millions of women with depression and/or those using antidepressants.”

“Depression is a very serious medical condition. It deserves to be treated, and it’s nice that these women can take the antidepressants, which so effectively treat this condition without worry that they’re doing something that would adversely affect their breast cancer risk in the future,” she concluded, noting that more sophisticated analyses of the data are planned to consider additional variables, including treatment duration. The analyses will also be repeated in the Nurses’ Health Study II cohort, which is a younger cohort with a higher incidence of premenopausal breast cancer and a greater prevalence of both depression and antidepressant use.

BIRMINGHAM, ALA. – Neither depression nor antidepressant use are associated with an increased risk of breast cancer among participants in the Nurses’ Health Study, according to an analysis of data from 67,120 women enrolled in the ongoing prospective cohort study.

Of the women included in the analysis, 2,904 had confirmed breast cancer as of the end of December 2012, including 2,333 with invasive disease. After adjusting for age, body mass index, and menopausal status, no statistically significant associations were seen between invasive or in situ breast cancer and depression or antidepressant use, Katherine W. Reeves, Ph.D. reported at the annual meeting of the American Society of Preventive Oncology.

The point estimates for the odds ratios were all below 1 for in situ disease, indicating a potential protective effect of depression, Dr. Reeves said.

“These were not statistically significant, so I would caution against overinterpreting the results, but it is kind of curious,” she said, noting that the finding may indicate that depressed women are less likely than nondepressed women are to have a mammogram – and thus are less likely to have the opportunity to be diagnosed with in situ disease.

When depression and antidepressant use were included together in the same model, they remained unassociated with breast cancer risk (odds ratio, 0.87), said Dr. Reeves of the University of Massachusetts Amherst.

Study subjects were an average age of 66 years, 8.7% were clinically depressed, and 9.7% used antidepressants. Data on depression and antidepressant use among Nurses’ Health Study participants were collected simultaneously beginning in 2000.

Depression and antidepressant use were self-reported, and depressive symptoms were confirmed using the five-item Mental Health Inventory.

The findings are encouraging; depression and antidepressant use are common and both have been hypothesized to increase breast cancer risk. Some prior studies have found a link between either depression or antidepressant use and breast cancer, and others have not – but most have had important limitations, including retrospective design and inclusion of major depression only, among others, she said.

“To me, though, the most important limitation is that previous studies have not evaluated depression and antidepressant use together,” Dr. Reeves said.

In the current study, which did consider both, no evidence was seen to suggest that depression or antidepressant use affects breast cancer risk.

“It’s typically very unexciting to have to report null results, but in this case, I think this is excellent news and really the best we could have hoped for,” she said, adding that although they are preliminary, the findings should be “very reassuring for the millions of women with depression and/or those using antidepressants.”

“Depression is a very serious medical condition. It deserves to be treated, and it’s nice that these women can take the antidepressants, which so effectively treat this condition without worry that they’re doing something that would adversely affect their breast cancer risk in the future,” she concluded, noting that more sophisticated analyses of the data are planned to consider additional variables, including treatment duration. The analyses will also be repeated in the Nurses’ Health Study II cohort, which is a younger cohort with a higher incidence of premenopausal breast cancer and a greater prevalence of both depression and antidepressant use.

BIRMINGHAM, ALA.– The time to colonoscopy after a positive fecal occult blood test varied widely between health systems and also varied based on age and comorbidity score, in a study of more than 62,000 patients from four health systems

The median time to colonoscopy after a positive fecal occult blood test (FOBT) in 62,384 patients in the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) Network ranged from 41 to 174 days. Most of those who received a follow-up colonoscopy did so within 3-6 months of their positive FOBT.

GroupHealth Research Institute

The percentage of patients followed up with colonoscopy within 12 months ranged from 58.1% to 83.8%, with lowest percentages occurring in the two systems with the longest median time to follow-up, Jessica Chubak, Ph.D., of Group Health Research Institute and her colleagues reported in a poster at the American Society of Preventive Oncology annual meeting.

The rate of colonoscopy follow-up within 12 months also decreased with advancing age and increasing Charlson comorbidity score. For those aged 55-59 years, 60-64 years, 65-69 years, or 70-75 years, the hazard ratios for follow-up were 1.02, 0.98, 0.98, and 0.90, respectively, compared with the youngest age group (50-54 years). But for those patients aged 76-84 years or 85-89 years, the hazard ratios were 0.65 and 0.34, respectively.

For those with a Charlson comorbidity score of 1, 2, or 3 or more, the adjusted hazard ratios for follow-up of were 0.93, 0.87, and 0.70, respectively, compared with those with a score of 0, the investigators said.

No significant differences in follow-up were seen based on gender, body mass index, or race/ethnicity.

The investigators used administrative and clinical data to estimate the time to follow-up and probability of follow-up for all persons with a positive FOBT in 2011 and 2012.

The findings have implications for future research on improving follow-up in older patients and those with comorbidities, the study authors said.

The differences between health care systems may be due to varying practices. The two organizations with the best time to colonoscopy follow-up in the network are health maintenance organizations with targets for time to colonoscopy and monitored appointment supply.

In contrast, the organization with the second longest time to follow-up was an HMO that contracted with external providers for about 60% of colonoscopies. The organization with the longest time to follow-up was a safety-net system with limited colonoscopy capacity that served socioeconomically disadvantaged patients who may have faced more barriers to colonoscopy completion.

Colorectal cancer is the fourth most common cancer in the United States, and FOBT is an important screening strategy that relies on follow-up in the event of a positive finding.

“Our findings that both individual-level factors as well as health care system were associated with follow-up strengthens the rationale for investigating multilevel interventions to improve follow-up after abnormal screening tests,” the researchers concluded.

The National Cancer Institute funded the study.

BIRMINGHAM, ALA.– The time to colonoscopy after a positive fecal occult blood test varied widely between health systems and also varied based on age and comorbidity score, in a study of more than 62,000 patients from four health systems

The median time to colonoscopy after a positive fecal occult blood test (FOBT) in 62,384 patients in the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) Network ranged from 41 to 174 days. Most of those who received a follow-up colonoscopy did so within 3-6 months of their positive FOBT.

GroupHealth Research Institute

The percentage of patients followed up with colonoscopy within 12 months ranged from 58.1% to 83.8%, with lowest percentages occurring in the two systems with the longest median time to follow-up, Jessica Chubak, Ph.D., of Group Health Research Institute and her colleagues reported in a poster at the American Society of Preventive Oncology annual meeting.

The rate of colonoscopy follow-up within 12 months also decreased with advancing age and increasing Charlson comorbidity score. For those aged 55-59 years, 60-64 years, 65-69 years, or 70-75 years, the hazard ratios for follow-up were 1.02, 0.98, 0.98, and 0.90, respectively, compared with the youngest age group (50-54 years). But for those patients aged 76-84 years or 85-89 years, the hazard ratios were 0.65 and 0.34, respectively.

For those with a Charlson comorbidity score of 1, 2, or 3 or more, the adjusted hazard ratios for follow-up of were 0.93, 0.87, and 0.70, respectively, compared with those with a score of 0, the investigators said.

No significant differences in follow-up were seen based on gender, body mass index, or race/ethnicity.

The investigators used administrative and clinical data to estimate the time to follow-up and probability of follow-up for all persons with a positive FOBT in 2011 and 2012.

The findings have implications for future research on improving follow-up in older patients and those with comorbidities, the study authors said.

The differences between health care systems may be due to varying practices. The two organizations with the best time to colonoscopy follow-up in the network are health maintenance organizations with targets for time to colonoscopy and monitored appointment supply.

In contrast, the organization with the second longest time to follow-up was an HMO that contracted with external providers for about 60% of colonoscopies. The organization with the longest time to follow-up was a safety-net system with limited colonoscopy capacity that served socioeconomically disadvantaged patients who may have faced more barriers to colonoscopy completion.

Colorectal cancer is the fourth most common cancer in the United States, and FOBT is an important screening strategy that relies on follow-up in the event of a positive finding.

“Our findings that both individual-level factors as well as health care system were associated with follow-up strengthens the rationale for investigating multilevel interventions to improve follow-up after abnormal screening tests,” the researchers concluded.

The National Cancer Institute funded the study.

BIRMINGHAM, ALA.– The time to colonoscopy after a positive fecal occult blood test varied widely between health systems and also varied based on age and comorbidity score, in a study of more than 62,000 patients from four health systems

The median time to colonoscopy after a positive fecal occult blood test (FOBT) in 62,384 patients in the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) Network ranged from 41 to 174 days. Most of those who received a follow-up colonoscopy did so within 3-6 months of their positive FOBT.

GroupHealth Research Institute

The percentage of patients followed up with colonoscopy within 12 months ranged from 58.1% to 83.8%, with lowest percentages occurring in the two systems with the longest median time to follow-up, Jessica Chubak, Ph.D., of Group Health Research Institute and her colleagues reported in a poster at the American Society of Preventive Oncology annual meeting.

The rate of colonoscopy follow-up within 12 months also decreased with advancing age and increasing Charlson comorbidity score. For those aged 55-59 years, 60-64 years, 65-69 years, or 70-75 years, the hazard ratios for follow-up were 1.02, 0.98, 0.98, and 0.90, respectively, compared with the youngest age group (50-54 years). But for those patients aged 76-84 years or 85-89 years, the hazard ratios were 0.65 and 0.34, respectively.

For those with a Charlson comorbidity score of 1, 2, or 3 or more, the adjusted hazard ratios for follow-up of were 0.93, 0.87, and 0.70, respectively, compared with those with a score of 0, the investigators said.

No significant differences in follow-up were seen based on gender, body mass index, or race/ethnicity.

The investigators used administrative and clinical data to estimate the time to follow-up and probability of follow-up for all persons with a positive FOBT in 2011 and 2012.

The findings have implications for future research on improving follow-up in older patients and those with comorbidities, the study authors said.

The differences between health care systems may be due to varying practices. The two organizations with the best time to colonoscopy follow-up in the network are health maintenance organizations with targets for time to colonoscopy and monitored appointment supply.

In contrast, the organization with the second longest time to follow-up was an HMO that contracted with external providers for about 60% of colonoscopies. The organization with the longest time to follow-up was a safety-net system with limited colonoscopy capacity that served socioeconomically disadvantaged patients who may have faced more barriers to colonoscopy completion.

Colorectal cancer is the fourth most common cancer in the United States, and FOBT is an important screening strategy that relies on follow-up in the event of a positive finding.

“Our findings that both individual-level factors as well as health care system were associated with follow-up strengthens the rationale for investigating multilevel interventions to improve follow-up after abnormal screening tests,” the researchers concluded.

The National Cancer Institute funded the study.

BIRMINGHAM, ALA. – Determining whether patients prefer colonoscopy or a stool sample blood test for colorectal cancer screening, and then providing support for completing the preferred method, could increase screening rates and reduce racial disparities in screening, according to findings from two randomized, controlled trials.

Such “tailored navigation” was superior to a standard intervention in the first of the two trials, which compared these approaches with usual care in general-population primary care patients from 10 practices. The patients were considered nonadherent, because they had not undergone colorectal cancer screening.

Screening adherence at 6 months was highest at 38% in 312 patients randomized to the tailored navigation intervention, compared with 33% in 316 patients randomized to receive the standard intervention. Adherence was only 12% among 317 patients in the usual care control group, Ronald E. Myers, Ph.D., of Thomas Jefferson University, Philadelphia, said at the annual meeting of the American Society of Preventive Oncology.

That study, by Dr. Myers and his colleagues, was published in 2013 (Cancer Epidemiol. Biomarkers Prev. 2013;22:109-17).

Patients in the tailored navigation group were sent either colonoscopy instructions or stool blood tests, depending on their reported test preference at baseline. If they had no preference, they received both. All patients in that group also received a mailed reminder and a navigation call to help encourage test use.

The standard intervention group was sent both colonoscopy instructions and stool blood tests, as well as a mailed reminder.

A total of 42% of patients had no preference regarding type of screening test, 39% preferred colonoscopy, and 19% preferred stool testing. “That may be a surprise, but their primary care physicians are not pushing stool blood testing,” Dr. Myers said. “They are pushing and promoting colonoscopy.”

The difference in screening adherence was significant for both the tailored intervention and standard intervention groups, compared with the control group, but was not significant between the two intervention groups.

A secondary analysis showed that mailing the colonoscopy instructions and blood test had a substantial effect on overall screening, and that the navigation calls also had an effect on overall screening and on colonoscopy.

Patients who were mailed only the colonoscopy instructions were much less likely to do stool blood testing – largely because it wasn’t being offered in their primary care practice. However, those who received both colonoscopy instructions and a stool blood test were much more likely to do stool blood testing.

In a similar study involving only noncompliant African American primary care patients, Dr. Myers and his colleagues found that adherence at 6 months was significantly greater in 384 patients randomized to tailored navigation than in 380 patients who were randomized to the standard intervention (odds ratio, 2.1), and positive change in overall screening preference was also significantly greater in the tailored navigation group (odds ratio, 1.5).

As in the first study, the tailored intervention in the second study (J. Natl. Cancer Inst. 2014;106:pii:dju344) involved a mailed stool blood test kit or colonoscopy instructions based on patient preference. But those with no preference received only colonoscopy instructions rather than receiving both instructions and a stool blood test.

All those in the tailored navigation groups received a telephone call to encourage screening, as well as a mailed reminder. The standard intervention group received a mailed stool blood test kit, colonoscopy instructions, and a mailed reminder.

The test preferences in the second study were similar to those in the first study, with 57% having no preference, 25% of patients preferring colonoscopy, and 18% preferring stool blood testing. A survey at 6 months and a medical records review at 12 months were conducted to assess adherence, changes in screening preference, and perceptions about screening.

Despite those with no preference receiving only the colonoscopy instructions, the tailored navigation group had a significantly higher screening rate than did the standard intervention group (38% vs. 24%), Dr. Myer noted.

The higher adherence was attributed to a high screening rate (50%) among those who preferred and received the stool blood test and navigation calls. The adherence rate was 35% in those who received the colonoscopy instructions and the navigation call.

“We believe it’s the case that mailing both stool blood test and colonoscopy materials in this case increased overall adherence, but that was mostly due to stool blood testing,” Dr. Myer said. Tailored navigation increased overall adherence primarily by boosting both stool blood testing and colonoscopy.

“Preference actually influenced, not necessarily overall screening, but what type of test was performed,” he added, noting that among African Americans, tailored navigation had a greater effect on overall adherence than did the mailed stool blood test and colonoscopy materials.

“We believe that tailored navigation with mailed stool blood testing and colonoscopy materials for everyone may increase screening adherence and also reduce screening disparity,” Dr. Myer noted, adding that it appears best to offer both tests, identify the preferred test, and provide support for the performance of that preferred test.

Additional research is needed to determine how to maximize the effects of tailored navigation and to determine its impact on racial disparities in colorectal cancer outcomes, Dr. Myer said. A study similar in design to those conducted in general and African American populations is underway in a Hispanic population, he added. Dr. Myers reported having no disclosures.

BIRMINGHAM, ALA. – Determining whether patients prefer colonoscopy or a stool sample blood test for colorectal cancer screening, and then providing support for completing the preferred method, could increase screening rates and reduce racial disparities in screening, according to findings from two randomized, controlled trials.

Such “tailored navigation” was superior to a standard intervention in the first of the two trials, which compared these approaches with usual care in general-population primary care patients from 10 practices. The patients were considered nonadherent, because they had not undergone colorectal cancer screening.

Screening adherence at 6 months was highest at 38% in 312 patients randomized to the tailored navigation intervention, compared with 33% in 316 patients randomized to receive the standard intervention. Adherence was only 12% among 317 patients in the usual care control group, Ronald E. Myers, Ph.D., of Thomas Jefferson University, Philadelphia, said at the annual meeting of the American Society of Preventive Oncology.

That study, by Dr. Myers and his colleagues, was published in 2013 (Cancer Epidemiol. Biomarkers Prev. 2013;22:109-17).

Patients in the tailored navigation group were sent either colonoscopy instructions or stool blood tests, depending on their reported test preference at baseline. If they had no preference, they received both. All patients in that group also received a mailed reminder and a navigation call to help encourage test use.

The standard intervention group was sent both colonoscopy instructions and stool blood tests, as well as a mailed reminder.

A total of 42% of patients had no preference regarding type of screening test, 39% preferred colonoscopy, and 19% preferred stool testing. “That may be a surprise, but their primary care physicians are not pushing stool blood testing,” Dr. Myers said. “They are pushing and promoting colonoscopy.”

The difference in screening adherence was significant for both the tailored intervention and standard intervention groups, compared with the control group, but was not significant between the two intervention groups.

A secondary analysis showed that mailing the colonoscopy instructions and blood test had a substantial effect on overall screening, and that the navigation calls also had an effect on overall screening and on colonoscopy.

Patients who were mailed only the colonoscopy instructions were much less likely to do stool blood testing – largely because it wasn’t being offered in their primary care practice. However, those who received both colonoscopy instructions and a stool blood test were much more likely to do stool blood testing.

In a similar study involving only noncompliant African American primary care patients, Dr. Myers and his colleagues found that adherence at 6 months was significantly greater in 384 patients randomized to tailored navigation than in 380 patients who were randomized to the standard intervention (odds ratio, 2.1), and positive change in overall screening preference was also significantly greater in the tailored navigation group (odds ratio, 1.5).

As in the first study, the tailored intervention in the second study (J. Natl. Cancer Inst. 2014;106:pii:dju344) involved a mailed stool blood test kit or colonoscopy instructions based on patient preference. But those with no preference received only colonoscopy instructions rather than receiving both instructions and a stool blood test.

All those in the tailored navigation groups received a telephone call to encourage screening, as well as a mailed reminder. The standard intervention group received a mailed stool blood test kit, colonoscopy instructions, and a mailed reminder.

The test preferences in the second study were similar to those in the first study, with 57% having no preference, 25% of patients preferring colonoscopy, and 18% preferring stool blood testing. A survey at 6 months and a medical records review at 12 months were conducted to assess adherence, changes in screening preference, and perceptions about screening.

Despite those with no preference receiving only the colonoscopy instructions, the tailored navigation group had a significantly higher screening rate than did the standard intervention group (38% vs. 24%), Dr. Myer noted.

The higher adherence was attributed to a high screening rate (50%) among those who preferred and received the stool blood test and navigation calls. The adherence rate was 35% in those who received the colonoscopy instructions and the navigation call.

“We believe it’s the case that mailing both stool blood test and colonoscopy materials in this case increased overall adherence, but that was mostly due to stool blood testing,” Dr. Myer said. Tailored navigation increased overall adherence primarily by boosting both stool blood testing and colonoscopy.

“Preference actually influenced, not necessarily overall screening, but what type of test was performed,” he added, noting that among African Americans, tailored navigation had a greater effect on overall adherence than did the mailed stool blood test and colonoscopy materials.

“We believe that tailored navigation with mailed stool blood testing and colonoscopy materials for everyone may increase screening adherence and also reduce screening disparity,” Dr. Myer noted, adding that it appears best to offer both tests, identify the preferred test, and provide support for the performance of that preferred test.

Additional research is needed to determine how to maximize the effects of tailored navigation and to determine its impact on racial disparities in colorectal cancer outcomes, Dr. Myer said. A study similar in design to those conducted in general and African American populations is underway in a Hispanic population, he added. Dr. Myers reported having no disclosures.

BIRMINGHAM, ALA. – Determining whether patients prefer colonoscopy or a stool sample blood test for colorectal cancer screening, and then providing support for completing the preferred method, could increase screening rates and reduce racial disparities in screening, according to findings from two randomized, controlled trials.

Such “tailored navigation” was superior to a standard intervention in the first of the two trials, which compared these approaches with usual care in general-population primary care patients from 10 practices. The patients were considered nonadherent, because they had not undergone colorectal cancer screening.

Screening adherence at 6 months was highest at 38% in 312 patients randomized to the tailored navigation intervention, compared with 33% in 316 patients randomized to receive the standard intervention. Adherence was only 12% among 317 patients in the usual care control group, Ronald E. Myers, Ph.D., of Thomas Jefferson University, Philadelphia, said at the annual meeting of the American Society of Preventive Oncology.

That study, by Dr. Myers and his colleagues, was published in 2013 (Cancer Epidemiol. Biomarkers Prev. 2013;22:109-17).

Patients in the tailored navigation group were sent either colonoscopy instructions or stool blood tests, depending on their reported test preference at baseline. If they had no preference, they received both. All patients in that group also received a mailed reminder and a navigation call to help encourage test use.

The standard intervention group was sent both colonoscopy instructions and stool blood tests, as well as a mailed reminder.

A total of 42% of patients had no preference regarding type of screening test, 39% preferred colonoscopy, and 19% preferred stool testing. “That may be a surprise, but their primary care physicians are not pushing stool blood testing,” Dr. Myers said. “They are pushing and promoting colonoscopy.”

The difference in screening adherence was significant for both the tailored intervention and standard intervention groups, compared with the control group, but was not significant between the two intervention groups.

A secondary analysis showed that mailing the colonoscopy instructions and blood test had a substantial effect on overall screening, and that the navigation calls also had an effect on overall screening and on colonoscopy.

Patients who were mailed only the colonoscopy instructions were much less likely to do stool blood testing – largely because it wasn’t being offered in their primary care practice. However, those who received both colonoscopy instructions and a stool blood test were much more likely to do stool blood testing.

In a similar study involving only noncompliant African American primary care patients, Dr. Myers and his colleagues found that adherence at 6 months was significantly greater in 384 patients randomized to tailored navigation than in 380 patients who were randomized to the standard intervention (odds ratio, 2.1), and positive change in overall screening preference was also significantly greater in the tailored navigation group (odds ratio, 1.5).

As in the first study, the tailored intervention in the second study (J. Natl. Cancer Inst. 2014;106:pii:dju344) involved a mailed stool blood test kit or colonoscopy instructions based on patient preference. But those with no preference received only colonoscopy instructions rather than receiving both instructions and a stool blood test.

All those in the tailored navigation groups received a telephone call to encourage screening, as well as a mailed reminder. The standard intervention group received a mailed stool blood test kit, colonoscopy instructions, and a mailed reminder.

The test preferences in the second study were similar to those in the first study, with 57% having no preference, 25% of patients preferring colonoscopy, and 18% preferring stool blood testing. A survey at 6 months and a medical records review at 12 months were conducted to assess adherence, changes in screening preference, and perceptions about screening.

Despite those with no preference receiving only the colonoscopy instructions, the tailored navigation group had a significantly higher screening rate than did the standard intervention group (38% vs. 24%), Dr. Myer noted.

The higher adherence was attributed to a high screening rate (50%) among those who preferred and received the stool blood test and navigation calls. The adherence rate was 35% in those who received the colonoscopy instructions and the navigation call.

“We believe it’s the case that mailing both stool blood test and colonoscopy materials in this case increased overall adherence, but that was mostly due to stool blood testing,” Dr. Myer said. Tailored navigation increased overall adherence primarily by boosting both stool blood testing and colonoscopy.

“Preference actually influenced, not necessarily overall screening, but what type of test was performed,” he added, noting that among African Americans, tailored navigation had a greater effect on overall adherence than did the mailed stool blood test and colonoscopy materials.

“We believe that tailored navigation with mailed stool blood testing and colonoscopy materials for everyone may increase screening adherence and also reduce screening disparity,” Dr. Myer noted, adding that it appears best to offer both tests, identify the preferred test, and provide support for the performance of that preferred test.

Additional research is needed to determine how to maximize the effects of tailored navigation and to determine its impact on racial disparities in colorectal cancer outcomes, Dr. Myer said. A study similar in design to those conducted in general and African American populations is underway in a Hispanic population, he added. Dr. Myers reported having no disclosures.