Djenaba A. Joseph

Understanding the burden of human papillomavirus‐associated anal cancers in the US

Anal cancer is an uncommon malignancy in the US; up to 93% of anal cancers are associated with human papillomavirus.

Implementing screening for Lynch syndrome among patients with newly diagnosed colorectal cancer: summary of a public health/clinical collaborative meeting

Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions which emerged from the meeting. It was recognized that widespread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidence-based genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships.Genet Med 2012:14(1):152–162

National evidence on the use of shared decision making in prostate-specific antigen screening.

PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making—a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%–90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%–43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. CONCLUSIONS Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.

The Colorectal Cancer Control Program: partnering to increase population level screening

w t s a t e h s o P v Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, killing more nonsmokers than any other cancer.1 In 2006, more than 139,000 people were diagnosed with CRC and more than 53,000 died of the disease.2 Screening can effectively decrease CRC incidence and mortality in 2 ways: first, unlike most cancers, screening offers the opportunity to prevent cancer by removing premalignant polyps; second, screening can detect CRC early when treatment is more effective.3,4 If CRC is diagnosed at early stages, the 5-year survival rate is more than 88%.5 In a modeling study to assess deaths revented through increased use of clinical preventive ervices, Farley et al6 estimated that 1900 deaths could be revented for every 10% increase in CRC screening with a olonoscopy. The U.S. Preventive Services Task Force recommends RC screening for average-risk individuals beginning at ge 50 by using annual high-sensitivity fecal occult blood esting, sigmoidoscopy every 5 years, or colonoscopy evry 10 years.7 Data from the Centers for Disease Control nd Prevention (CDC) suggest that only 62.9% of Amerians aged 50 to 75 years are up to date with CRC screenng, with more than 22 million adults estimated to be

Strategies for Expanding Colorectal Cancer Screening at Community Health Centers

Community health centers are uniquely positioned to address disparities in colorectal cancer (CRC) screening as they have addressed other disparities. In 2012, the federal Health Resources and Services Administration, which is the funding agency for the health center program, added a requirement that health centers report CRC screening rates as a standard performance measure. These annually reported, publically available data are a major strategic opportunity to improve screening rates for CRC. The Patient Protection and Affordable Care Act enacted provisions to expand the capacity of the federal health center program. The recent report of the Institute of Medicine on integrating public health and primary care included an entire section devoted to CRC screening as a target for joint work. These developments make this the ideal time to integrate lifesaving CRC screening into the preventive care already offered by health centers. This article offers 5 strategies that address the challenges health centers face in increasing CRC screening rates. The first 2 strategies focus on improving the processes of primary care. The third emphasizes working productively with other medical providers and institutions. The fourth strategy is about aligning leadership. The final strategy is focused on using tools that have been derived from models that work. CA Cancer J Clin 2013;63:221–231. ©2013 American Cancer Society, Inc.

Clinical outcomes from the CDC's Colorectal Cancer Screening Demonstration Program

Colorectal cancer remains the second leading cause of cancer‐related deaths among US men and women. Screening rates have been slow to increase, and disparities in screening remain.

New Roles for Public Health in Cancer Screening

Screening tests for the early detection of breast, cervical, and colorectal cancer are prioritized clinical preventive services that can reduce the burden of cancer in the United States. 1 While significant progress has been made in this area, screening rates for breast and cervical cancers have not improved in almost a decade and rates for colorectal cancer are unacceptably low. Lack of insurance has traditionally been the main factor preventing adults from obtaining cancer screening. 2 Components of the Patient Protection and Affordable Care Act will help address this through Medicaid expansion, subsidized state insurance exchanges, and the elimination of cost sharing. However, access to health insurance and medical care are not the only factors that limit participation in cancer screening. Many people who currently have health insurance and regular access to medical care are not being screened. Based on 2010 National Health Interview Survey data, among adults aged 50 to 75 years with a regular source of medical care, only 62% were up to date with screening for colorectal cancer and only 75% of women in this age range had received a mammogram within the preceding 2 years. 3 Analyses of national Medicare data revealed that, despite coverage of cancer screening services, only 66% of eligible women had undergone a mammogram within the past 2 years 4 and only 47% of adults had insurance claims documenting adequate screening for colorectal cancer. 5 To realize the full potential of anticipated improvements in access to care, public health must provide leadership to ensure that cancer screening is proactive, organized, and equitable.

Association Between Glomerular Filtration Rate, Free, Total, and Percent Free Prostate-specific Antigen

OBJECTIVES To determine the relationship between glomerular filtration rate (GFR) and free prostate-specific antigen (fPSA), percent-free PSA (%fPSA), and total PSA (tPSA) in patients with diminished kidney function not on dialysis, using nationally representative data. METHODS A total of 3782 men aged ≥ 40 years who participated in the National Health and Nutrition Examination Survey 2001-2006, and who met eligibility criteria for PSA testing were included in the final study population. GFR (mL/min/1.73 m(2)) was calculated using the Modification of Diet in Renal Disease equation 7 and categorized as ≥ 90, 60 to < 90, and 15 to < 60. Distribution of tPSA, fPSA, and %fPSA were estimated by GFR category and by age and race. Multivariate linear regression models were fit to determine the adjusted relationship between GFR and tPSA and %fPSA after adjusting for age, race, and body mass index. RESULTS The multivariate linear regression analysis showed that GFR had a linear relationship with tPSA that was of borderline significance. There was a significant nonlinear relationship between GFR and %fPSA (P < .001): increased GFR was associated with a decrease in %fPSA for GFR levels below 90 [eg, change in %fPSA = -2.67 (95% CI -3.56, -1.77) for a GFR of 85 as compared with 65; P < .001]. The decline in %fPSA with increasing GFR was nonsignificant for GFR levels above 90. CONCLUSIONS Our finding that renal function as measured by GFR is negatively associated with %fPSA has potential implications for use of this test in men with renal disease.

Colorectal Cancer Screening: Estimated Future Colonoscopy Need and Current Volume and Capacity

In 2014, a national campaign was launched to increase colorectal cancer (CRC) screening rates in the United States to 80% by 2018; it is unknown whether there is sufficient colonoscopy capacity to reach this goal. This study estimated the number of colonoscopies needed to screen 80% of the eligible population with fecal immunochemical testing (FIT) or colonoscopy and determined whether there was sufficient colonoscopy capacity to meet the need.

The National Breast and Cervical Cancer Early Detection Program in the era of health reform: A vision forward

For the last 22 years, the Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided high quality breast and cervical cancer screening to women who do not have health insurance or who have inadequate insurance. As the health care landscape changes, it is time for CDC to address new identified needs and opportunities to increase cancer screening and to further explore new or expanded roles for the program looking to the future. The NBCCEDP is well positioned to build upon its experience, established clinical and community partnerships, and success in serving disadvantaged and diverse populations to address important barriers to cancer screening that will persist as health reform is implemented. Additionally, the program can adapt its extensive experience with establishing and managing an organized system of delivering cancer screening and apply it to promote a more organized approach to screening through health care systems on a population level. Emphasis is placed on the implementation of evidenced‐based interventions proven effective in increasing cancer screening rates, promising practices and other organizational policy and health systems interventions. Cancer 2014;120(16 suppl):2620‐4. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.