A systems perspective on rural and remote colorectal cancer screening access

This study assessed the referral and completion rates of colorectal cancer screening with fecal immunochemical test (FIT) in a primary care medical home serving an underserved population. The Good Samaritan Clinic (Clinic) provides medical care to over 600 uninsured clients annually and is staffed by volunteer health care providers (Providers). All clients have an income at or below 200 % of the Federal Poverty Line; 63.8 % are Latino or Hispanic, 22.3 % are non-Hispanic Caucasians, and 10.1 % are African American. Acute client care for co-morbidities such as hypertension and uncontrolled diabetes is often the focus of clinical visits, thus limiting health promotion referrals, including routine cancer screenings. To promote evidence-based recommended cancer screenings the Clinic and the Lewis Cancer & Research Pavilion utilized guidelines from the American Cancer Society, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network to create a Cancer Assessment Tool (CAT) with age and sex appropriate screenings for breast, cervical, prostate, colorectal, and head and neck cancers. This cancer screening intervention was implemented in March 2013. During clinic visits, Providers used the CAT to review age and sex recommended cancer screenings and then, based on the CAT, referred clients as indicated. For example, if colorectal cancer screening was indicated based on age or family history, the CAT prompted the Provider to give the client a FIT to take home and to also counsel the client on how to collect the sample and return the test. No other interventions to promote FIT referral, FIT completion, or other colorectal screening methods were implemented during this time. To evaluate Provider FIT referrals and client FIT return compliance, data on CAT implementation was collected from March 28 – July 31, 2013. Measurements collected included the number of clients eligible for age-appropriate colorectal cancer screening; the number of clients with whom the CAT was completed; the number of clients given FIT; the number of FIT returned; and the number of positive FIT. Providers utilized the CAT to consider screening for colorectal cancer based on age and family history with 25.5 % (110) of the 431 total clients seen at the Clinic during this time period. Review of medical records indicate that 34.8 % (150) of total clients met age only criteria (over age 50) for colorectal cancer screening. Of the 150 total age-eligible clients (not considering additional clients with family history), 44.7 % (67) were referred for colorectal screening and were given a take-home FIT. Of the 67 clients given a FIT, 53.7 % (36) returned the results, resulting in a FIT completion rate of 24 % of all 150 age-eligible clients. 100 % (36) of FIT exams returned were negative. FIT drop-off occurred at both the provider referral level (55.3 % non-referral rate) and the client completion level (46.3 % non-completion rate). Based on these drop-off points several provider and client-based interventions recommended by the Guide to Community Preventive Services (Community Guide) may support improved colorectal cancer screening completion. First, strengthening provider-based interventions such as provider feedback and reminder systems so that the CAT is utilized for all client visits may support increased referral for FIT screening. Second, client-based interventions such as one-on-one education, client reminders such as follow-up phone calls, and reducing structural barriers such as putting postage stamps on the FIT may support client compliance to complete and return the FIT. Potential exists to conduct similar analysis of the CAT with breast, cervical, prostate, and head and neck cancers. Citation Format: Sarah Dobra, Krista Aliffi, Sandra Bond. Referral and completion rates for colorectal cancer screening with fecal immunochemical test (FIT) in a medical home for underserved populations. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B75. doi:10.1158/1538-7755.DISP13-B75

Purpose: We partnered with a local Federally Qualified Health Center (FQHC) to test implementation of evidence-based interventions (EBI) promoting Fecal Immunochemical Test (FIT) CRC screening in an environment in which colonoscopy has been the prevailing screening strategy. We report on implementation adaptations and preliminary results. Background: Sociocultural and medical concerns are barriers to colonoscopy uptake in some populations. An additional barrier to CRC screening is system level capacity for colonoscopy that results in a back log of cases and long wait times. With Covid-19, the additional backlog in overdue CRC screening has underscored the need to expand FIT testing capacity to address screening needs and to pre-empt further racial/ethnic and SES disparities in CRC outcomes. This trial tests the unique and additive value of multiple EBIs for increasing CRC screening (primarily through FIT testing, but also colonoscopy when indicated) while evaluating the success of implementing these approaches. EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and assistance from community health workers. Methods: Participants (3500), ages 45-75, were identified from a large FQHC in New Haven, CT and determined to be overdue for CRC screening. Participants were randomly assigned to one of the four arms of the study: 1) Provider reminder (overdue for CRC screening) only; 2) Provider Reminder + SDOH short message and one-size-fits all link to resources; 3) Provider Reminder + SDOH short message and offer for individualized navigation (trained navigators from local community) to address SDOH and other barriers; 4) Provider Reminder + offer to participate in a CRC educational program as phase 2 of the NCI's Screen to Save program (not an EBI). Preliminary data on uptake of CRC screening will be presented. Results: With input from stakeholders, we have: 1) lowered age eligibility from 50 to 45 to align with new guidelines; 2) expanded the target population to 2 additional satellite clinics, more than doubling the proposed study enrollment; 3) incorporated design changes in the patient reminders. The collaboration between research team and clinician stakeholders has been critical in minimizing disruptions to clinical workflow while assuring fidelity to the evidence-based interventions. Preliminary outcomes (within one month of intervention) on uptake of intervention across the 4 arms of the study, i.e., referral for CRC screening and test completion will be presented. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx and/or low socioeconomic status individuals stem from the disproportionate burden of SDOH barriers. Findings will inform primary care setting implementation of EBIs to address the anticipated increase in disparities in CRC screening, exacerbated by COVID-19 changes in health care access and utilization, as well as the increased demand associated with the change in guidelines. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Sally A. DeGiovanni, Levita Y. Robinson, Michael J. Couturie, Denise Stevens, Monique K. Stefanou, Jose DeJesus, Eduardo Reyes, Jonathan Colon, Maryanne Cosgrove, Steven J. Parra. Implementing evidence-based interventions (EBI) to increase uptake of fecal immunochemical test (FIT) colorectal cancer (CRC) screening in Vulnerable Populations [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-025.

IntroductionColorectal cancer screening when done early can significantly reduce mortality. However, screening compliance is still lower than expected even in countries with established screening programs. Motivational interviewing is an approach that has been explored to promote behavioral change including screening compliance. This review synthesizes the efficacy of motivational interviewing in promoting uptake of colorectal screening modalities and is the only review so far that examines motivational interviewing for colorectal cancer screening alone.MethodsA systematic review and meta-analysis was conducted to examine the effects of motivational interviewing for colorectal cancer screening. PubMed, EMBASE, CENTRAL, PsycINFO, and CINAHL were searched to identify eligible studies from inception to June 2021 and selection criteria was defined. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The DerSimonian and Laird random effects model was used in the statistical analysis for studies included in the meta-analysis.ResultsFourteen studies from 14 randomized-controlled trials with a low to moderate risk of bias were analyzed. 8 studies in the systematic review showed that motivational interviewing is superior to a control group. Meta-analysis was conducted on 11 studies and showed that motivational interviewing is statistically significant in increasing colorectal cancer screening rates in both intention-to-treat and per-protocol analysis. Timing of data collection of colorectal cancer screening rates did not make a significant difference to the efficacy of motivational interviewing. Studies that offered and accepted a mixture of colorectal screening modalities such as colonoscopy and fecal immunochemical tests were significantly more likely to have favorable colorectal screening outcomes. Heterogeneity in intervention was noted between studies, specifically differences in the training of interventionists, intervention delivery and comparator components.ConclusionMotivational interviewing is a tailored intervention demonstrating mixed evidence in improving colorectal cancer screening attendance amongst individuals. More research is needed to rigorously compare the effect of motivational interviewing alone vs. in combination with other screening promotion strategies to enhance colorectal cancer screening compliance.

e22519 Background: Colorectal cancer screening has been associated with a marked reduction in cancer- related mortality, and the achievement of screening targets has been identified as a national objective by the Healthy People 2030 initiative. Although various social determinants of health (SDoH) have been demonstrated to impact healthcare access, the association between food insecurity (FI) and colorectal screening rates (CSR) remains unexplored. As such, we sought to assess the impact of FI on county-level colorectal screening rates (CSR). Methods: Data on county-level colorectal cancer screening and food insecurity rates in 2018 were extracted from the Centers for Disease Control (CDC) PLACES and County Health Rankings & Roadmaps databases, respectively. Notably, FI and CSR were categorized as low (lowest quartile), intermediate (middle two quartiles) and high (highest quartile). Multivariable logistic regression analyses were used to evaluate the association between FI and CSR. Results: Among 3,106 counties, the median CSR was 62.1% (IQR 58.9%–65.2%) and ranged from 39.8% (Kusilvak, Alaska) to 74.4% (Newport, Rhode Island). A majority of counties were urban (Metropolitan: n = 790, 25.4% vs. Urban: n = 1,671, 53.8% vs. Rural: n = 645, 20.8%). Overall, a fourth of counties had high screening rates (Low CSR : n = 788, 25.4% vs. Intermediate CSR : n = 1,545, 49.7% vs. High CSR : n = 773, 24.9%). Similarly, 25.0% of counties demonstrated high FI (Low FI : n = 777, 25.0% vs. Intermediate FI : n = 1,552, 50.0% vs. High FI: n = 777, 25.0%). Notably, counties with increasing FI were markedly less likely to have High CSR (Low FI : n = 353, 45.4% vs. Intermediate FI: n = 370, 23.8% vs. High FI: n = 50, 6.4%)(p<0.001). After adjusting for county-level rurality, population-to-primary care physician ratio, household income, unemployment, race/ethnicity, education and uninsurance, intermediate and high FI was associated with an incrementally lower likelihood of having High CSR compared with low FI counties (ref: Low FI ; Intermediate FI : OR 0.61, 95%CI 0.47–0.80; High FI : OR 0.31, 95%CI 0.20–0.50). Conclusions: Increasing county-level FI was independently associated with markedly lower colorectal cancer screening rates, indicating that FI may play a key role in driving disparities in access to cancer care. As such, policies targeted at vulnerable communities characterized by high food insecurity and social deprivation are critically needed to ensure equitable access to preventive cancer care measures such as colorectal cancer screening.

The effects of teamwork and system support on colorectal cancer screening in primary care practices

PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHODS: We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator; and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test; 2) completed test. Results by intervention will be assessed at 12 months. RESULTS: Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients “engaged” with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Sarah A. DeGiovanni, Steven J. Parra, Levita Robinson, Michael Couturie, Louie Mar Gangcuangco, Denise Stevens. Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT) [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A104.

Colon Cancer Screening Models: Lessons and Challenges

1539 Background: Clinical practice guidelines (CPGs) for cervical, breast, colorectal and prostate cancer screening are well- established. The purpose of this study was to determine how adherence to CPGs has changed over the past five years. Methods: The National Health Interview Survey is a population-based survey, designed to be representative of the entire civilian non-institutionalized population in the US. To determine trends in adherence to CPGs, data from the 2000 and 2005 surveys were analyzed using SAS and SAS-callable SUDAAN software. Results: There was a significant decline in women over the age of 21 reporting having had a PAP smear within the preceding three years and women over the age of 40 reporting having had a mammogram within the preceding two years over the period of 2000 to 2005. However, the rate of men over the age of 50 reporting having had a PSA did not significantly change over this period. The rate of colorectal cancer (CRC) screening with either proctoscopy, sigmoidoscopy or colonoscopy increased between 2000 and 2005. While an increase in CRC screening between 2000 and 2005 was observed in both women (32.3% to 39.9%, p<0.0001) and men (37.2% to 42.7%, p<0.0001), men were significantly more likely to report having had endoscopic screening than women, independent of survey year (p<0.0001). On multivariate analysis, controlling for insurance status, educational level and family income, the trends in colorectal, cervical and breast cancer between 2000 and 2005 remained significant. Conclusions: There has been a significant decline in adherence to breast and cervical cancer screening CPGs over the past five years, while CRC screening has improved over the same time period. Although rates of PAP smears and mammography are high compared with lower GI endoscopy and PSA testing, the decline in breast and cervical cancer screening is concerning. Number of people (%) P value 2000 2005 Univariate Multivariate PAP smear within past 3 yrs 13,538 (78.7) 12,215 (74.1) P<0.0001 P<0.0001 Mammogram within past 2 yrs 7,289 (68.5) 7,061 (65.5) P=0.0005 P=0.0003 Endoscopy within past 10 yrs 4,260 (34.5) 5,337 (41.2) P<0.0001 P<0.0001 PSA within the past yr 2,104 (46.0) 2,350 (54.0) P=0.7649 P=0.8681 No significant financial relationships to disclose.

Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention. Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies. Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis). An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.

Cannabis use has experienced partial legalization with a substantial rise over the past decades in the United States. The aim of this study was to evaluate the relationship between cannabis use frequency and adherence to recommended breast, prostate, cervical, and colorectal cancer screenings. We analyzed data from the Behavioral Risk Factor Surveillance System surveys, focusing on men and women eligible for recommended cancer screenings. The predictor variable was self-reported cannabis use, stratified by frequency (none, 1-19 days/month, 20-30 days/month). The main outcome variable was adherence to recommended breast, prostate, cervical, and colorectal screenings. A multivariable adjusted model was used to assess predictors of adherence. Overall, 229,711 patients (corresponding to a weighted population of 46.9 individuals eligible for screening) were included. High-frequency cannabis use (20-30 days) was associated with lower adherence to breast cancer screening (adjusted odds ratios [aORs], 0.70 [95% CI, 0.54 to 0.91]), while moderate use (1-19 days) showed no significant effect. Cannabis use at any frequency was associated with lower adherence to prostate cancer screening (1-19 days: aOR, 0.76 [95% CI, 0.58 to 0.98]; 20-30 days: aOR, 0.60 [95% CI, 0.44 to 0.82]). Cannabis use had no significant impact on adherence to cervical or colorectal cancer screening. Heavy cannabis use was associated with lower adherence to recommended breast and prostate cancer screenings, while moderate cannabis use was associated with reduced prostate cancer screening adherence only. This effect was not seen in cervical and colorectal cancer screening. Close monitoring of adherence to breast cancer screening in women and prostate cancer screening in men with frequent cannabis use might be beneficial.

6583 Background: Colorectal cancer (CRC) screening remains underutilized. Prior studies reported the cost-effectiveness of interventions to improve CRC screening, but none have been replicated in the setting of small medical practices. We recently conducted a randomized trial of an academic detailing strategy within 264 small physician offices in New York City. The objective of this analysis is to assess the cost-effectiveness of this intervention. Methods: 264 physician offices were randomized to usual care or to a series of ‘academic detailing’ visits from health educators trained in evidence-based CRC screening guidelines. CRC screening rates were measured at baseline and 12 months. Intervention-related costs were categorized as fixed or intervention delivery costs. The incremental cost effectiveness ratio (ICER) was expressed as cost per percentage point increase in CRC screening. Each practice contained an average of 4 physicians. Sensitivity analyses were estimated by varying the number of physicians per practice and accordingly, intervention delivery costs. Results: Academic detailing resulted in a 7% increase in CRC screening with colonoscopy. The cost of the intervention was $147,865. The ICER was $21,124 per percentage point increase in CRC screening. Sensitivity analyses that varied the intervention delivery costs by the average medical practice size were associated with ICERs ranging from $13,361 (8 physicians/office) to $36,109 (2 physicians/office) per percentage point increase in CRC screening rates. Conclusions: A multi-component academic detailing intervention conducted in small urban practices was clinically effective, but was not cost-effective when compared to other reported low-intensity patient-directed and infrastructural interventions ($131-$1,161 per percentage increase in CRC screening). (Table) While academic detailing may be more cost-effective in physician practices of larger size, new cost-effective approaches in small community practices are needed. [Table: see text] No significant financial relationships to disclose.

Background: Though colorectal cancer (CRC) screening rates have increased significantly over the past two decades, screening disparities persist among Latinos. To increase CRC screening rates among Latinos, a promotor-led intervention was implemented to provide educational workshops and link community members to screenings through a partnered Federally Qualified Health Center (FQHC). Aims: To assess screening completion at 6-months follow-up. To identify barriers influencing adherence to CRC screening among participants who participated in a promotor-led intervention. Methods: The Juntos Contra el Cáncer/Together Against Cancer (JUNTOS) program was a promotor-led cancer prevention study that provided CRC prevention workshops to adults ages 50 to 75 in a primarily Latino community in San Diego, CA. Based on the Social Ecological Framework, the intervention targeted knowledge of CRC, screening attitudes, social support, screening barriers, and linked participants to community resources. Promotors assisted participants in scheduling appointments, which is the first step in CRC screening at the partnering FQHC. From December 2016 to July 2018, a total of 66 participants who were not up to date with CRC screening attended a 2.5-hour workshop, received follow-up calls from promotors, and completed a 6-month assessment. Demographics, health conditions, CRC knowledge, and attitudes changes towards screening were compared between participants who completed a CRC screening (adherent) and those who did not at 6 months (nonadherent). Chi-squared and t-tests were conducted to assess significant differences among adherent and nonadherent participants. For nonadherent participants, barriers to scheduling an appointment were evaluated. Results: The sample included 66 Latinos ages 50 to 75 (women=70%). Results from the 6-month follow-up show that 59% participants reported completing CRC screening. Findings show a statistically significant decrease in negative attitudes towards CRC screening from baseline to follow-up (M1=2.88 [SD=.81], M2=2.53 [SD=.85], p&amp;lt;.001). Differences in demographics, health conditions, attitudes towards screening, CRC knowledge, and health behaviors were not statistically significant at baseline between adherent and nonadherent participants at follow-up. The most frequently reported barriers for nonadherent participants to schedule an appointment with their medical provider were being too busy (48%) and not having health insurance (41%). Conclusions: Preliminary findings suggest that the delivery of the promotor-led intervention improved attitudes of CRC screening and led to increases in self-reported screening rates among nonadherent adults. For uninsured participants, waiving the appointment or providing additional support to navigate the health system may help them complete CRC screening. Overall, these findings build the evidence on the preliminary efficacy of group-based CRC education and linkages to care for nonadherent adults. Citation Format: Carolina López de la Torre, Jill N. JoaDumbauld, Jessica Haughton, Anthony Barrios, Dalia Rojas, Mirna Díaz, José López, Maria Milla, Samir Gupta, Jesse Nodora, Christian Ramers, Felipe Garcia-Bigley, Jessica Marquez, Balambal Baharti, Elva M. Arredondo. Colorectal cancer screening completion rates and barriers to colorectal cancer screening 6 months following participation in CRC screening intervention [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B113.

Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.

154 Background: Cervical (CC), breast (BC), and colorectal (CRC) cancer screening rates lag for US Latinas compared to non-Latina white women. Obesity/overweight, a known cancer risk factor, is prevalent among Latinas, making cancer screening a pressing priority in this population. This study investigates determinants of CC, BC, and CRC screening adherence at baseline and screening uptake at study completion among overweight/obese Latinas in SANOS (Health and Nutrition for All), a 6-month culturally tailored lifestyle program with navigation to insurance, primary care, and screening. Methods: We enrolled 412 Spanish-speaking Latinas with BMI ≥25 kg/m 2 (2019-2024). Surveys conducted at baseline and study completion captured participants’ time in the US, English proficiency, primary care physician (PCP) access, health insurance status, and cancer screening adherence per USPSTF guidelines. Logistic regression assessed determinants of screening adherence, and Fisher’s exact tests compared screening uptake at study completion, with significance at p &lt; 0.05. Results: Of 412 participants (mean age 43.4 ± 9.7), 77.5% had limited English proficiency, and 39.9% were insured, mainly through Medicaid (73.0%). Baseline adherence was high for CC (75.7%; 311/411 eligible) and BC (66.5%; 165/248), while only 45.9% (68/148) for CRC. Logistic regression showed that more time living in the US (CRC: OR = 1.06, p = 0.001; BC: OR = 1.06, p &lt; 0.001), having insurance (CRC: OR = 2.97, p = 0.002; BC: OR = 2.26, p = 0.006), and more recent PCP access (CRC: OR = 0.08, p &lt; 0.001; BC: OR = 0.24, p &lt; 0.001) predicted CRC and BC adherence. Having insurance (OR = 1.76, p = 0.026) and more recent PCP access (OR = 0.24, p &lt; 0.001) predicted CC adherence. Participants reporting CC adherence were 13.3 (CI .95 = 5.38, 37.87) and 7.76 (CI .95 = 2.05, 50.87) times more likely to report BC and CRC adherence, respectively. At study completion, among those non-adherent at baseline, CRC uptake (13.6%, 9/66) was significantly lower than BC uptake (44.8%, 30/67; p &lt; 0.001) and CC uptake (35.8%, 24/67; p &lt; 0.018). Conclusions: High CC and BC screening adherence among overweight/obese Latinas demonstrates regular engagement with the healthcare system; however, disproportionately low CRC screening reflects a critical missed opportunity for prevention. Interventions to promote CRC screening adherence in this population should include both provider education and culturally tailored patient education on CRC risk and screening. Further research is needed on Latinas' perceived barriers to CRC screening and their awareness of screening options.

This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs). A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics. The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals. The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.