Citations

We conducted a survey of primary care clinicians and gastroenterologists (n = 938) between 11/06/19–12/06/19 to assess knowledge and attitudes regarding colorectal cancer screening. We assessed clinicians’ attitudes toward lowering the colorectal cancer screening initiation age to 45 years, a topic of current debate. We also evaluated provider and practice characteristics associated with agreement. Only 38.1% of primary care clinicians endorsed colorectal cancer screening initiation at age 45 years, compared to 75.5% of gastroenterologists (p < .0001). Gastroenterologists were over 5 times more likely than primary care clinicians to endorse lowering the screening initiation age (OR = 5.30, 3.54-7.93). Other factors found to be independently associated with agreement with colorectal cancer screening initiation at age 45 years included seeing more than 25 patients per day (vs. fewer) and suburban (vs. urban) location. Results emphasize the need for collaboration between primary care clinicians and gastroenterologists to ensure that patients receive consistent messaging and evidence-based care.

Abstract In 2016, we established the year-long Society of Behavioral Medicine (SBM) Mid-Career Leadership Institute. Individuals are often selected for leadership positions without intentional training in needed leadership skills, including strategic planning, building collaborative teams, goal setting, negotiation, and communication. The purpose of the Leadership Institute is to: (a) provide opportunities for mid-career professionals to build and sustain their leadership capacity; (b) create cohorts of connected fellows in behavioral medicine fields, disciplines, and institutions, who can support one another throughout their professional careers; and (c) enhance specific skills needed to navigate the challenges of mid-career. Over the first 4 years of the Institute, 139 fellows have participated, representing 35 states. Most of the fellows hold PhDs (93%) as a terminal degree. This special issue is dedicated to the leadership experiences of fellows, faculty, senior SBM mentors, peer mentors, and executive coaches.

Abstract In 2015, the Society of Behavioral Medicine (SBM) created the Mid-Career Leadership Institute. The initial model that motivated the creation of the institute came from my participation in the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) program, specifically designed to enhance the leadership skills of senior female faculty in the health sciences. My participation in ELAM was transformative. It led me to run for president of SBM in 2014, to consider how behavioral scientists could similarly benefit from mid-career leadership training, and ultimately to work with the SBM Executive Director, the SBM Leadership Institute Steering Committee, and leadership training professionals to launch the Leadership Institute in 2016. The overarching goal of the SBM Leadership Institute is to train mid-career behavioral scientists engaged in academic and health care settings to develop essential skills needed to navigate the unique challenges of mid-career. Central to this goal is a focus on integrating diversity, equity, and inclusion into their emerging leadership roles through participation in training exercises, lectures, and dynamic group discussions. To optimize the Leadership Institute experience, opportunities were developed, including mentoring from SBM seasoned members, peer mentoring through the creation of “learning communities,” career coaching, and additional networking opportunities. The purpose of this brief commentary is to summarize lessons learned by highlighting program evaluation, describing key changes over the initial 4 years, and sharing future plans for leadership training.

Abstract Introduction and Background: Mammography is thought to have an overall sensitivity of 87% according to the Breast Cancer Screening Consortium (BCSC). However, evidence from more recent studies indicate that a significant proportion of patients come into care with breast cancer symptoms, which trigger diagnosis rather than regular screening mammography. Women with breast cancer symptoms often have advanced cancer at diagnosis. This implies that previous negative mammograms are false negatives, and that screening mammography alone was insufficient for this population. Such populations include women with dense breasts, for whom mammography has a known 10-29% decrease in regardless of stage at diagnosis, and women who do not use screening mammography regularly or at all. Specific Experimental Aims: In a US population-based cohort of women who have developed first time breast cancer, we will 1) determine the variance in mode of detection, and 2) determine if mode of detection varied by breast density or by stage at diagnosis. Methods and Design: We identified a cohort of 386 women with a diagnosis of first time breast cancer (ICD codes) within a 7 county, 98.5% coverage population. We randomly sampled 30 women and performed chart review. The data were collated in REDCap, and reported with descriptive statistics. Results: In our pilot random sample (n=30), 33% (10/30) of women had DCIS, 30% (9/30) had non-advanced cancer, and 37% (11/30) had advanced cancer. For women with DCIS, 90% (9/10) were found with screening mammography, compared to only 44% (4/9) of non-advanced, and 45% (5/11) advanced cancers. Approximately 43% (13/30) of women in this sample had dense breasts. Interestingly, 61.5% (8/13) women with dense breasts, and 62.5% (10/16) of women with non-dense breasts had screening mammography as the mode of detection. Finally, among women with dense breasts, 46.1% (6/13) had DCIS, 30.8% (4/13) had non-advanced cancer, and 23.1% (3/13) had advanced cancer, while for women with non-dense breasts, 25% (4/16) had DCIS, 31.2% (5/16) had non-advanced cancer, and 43.8% (7/16) had advanced cancer. Conclusions and Future Directions: These pilot data suggest that our population reflects both the breast density rate (47%, BCSC) and the rate of advanced cancers (36%, SEER) found in the national population, and that there is a strong likelihood that regardless of breast density, but especially for non-DCIS, screening mammography alone may not be sufficient detect breast cancer (44-45%) compared to the BCSC statistic of 87%. This may be due to misattribution of mode of detection for breast cancer, especially in symptomatic later stages of disease. Once the full study is completed, future research regarding outcomes (mortality and otherwise) and stage at diagnosis for patients who use additional screening methods may be valuable. In addition, for women with lower access to, or who choose not to use screening mammography, future research regarding revisiting the use of SBE and CBE as well as other modalities may also be valuable. Citation Format: Susanna N Basappa, Lila JF Rutten. Variance in mode of detection for breast cancer by breast density and stage at diagnosis: A pilot study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C099.

Objective To identify the relationships between county-level area deprivation and patterns of both opioid prescriptions and drug-poisoning mortality. Design, setting and participants For this retrospective cross-sectional study, we used the IQVIA Xponent data to capture opioid prescriptions and Centres for Disease Control and Prevention National Vital Statistics System to assess drug-poisoning mortality. The Area Deprivation Index (ADI) is a composite measure of social determinants of health comprised of 17 US census indicators, spanning four socioeconomic domains. For all US counties with available opioid prescription (2712 counties) and drug-poisoning mortality (3133 counties) data between 2012 and 2017, we used negative binomial regression to examine the association between quintiles of county-level ADI and the rates of opioid prescriptions and drug-poisoning mortality adjusted for year, age, race and sex. Primary outcome measures County-level opioid prescription fills and drug-poisoning mortality. Results Between 2012 and 2017, overall rates of opioid prescriptions decreased from 96.6 to 72.2 per 100 people, while the rates of drug-poisoning mortality increased from 14.3 to 22.8 per 100 000 people. Opioid prescription and drug-poisoning mortality rates were consistently higher with greater levels of deprivation. The risk of filling an opioid prescription was 72% higher, and the risk of drug-poisoning mortality was 36% higher, for most deprived compared with the least deprived counties (both p<0.001). Discussion Counties with greater area-level deprivation have higher rates of filled opioid prescriptions and drug-poisoning mortality. Although opioid prescription rates declined across all ADI quintiles, the rates of drug-poisoning mortality continued to rise proportionately in each ADI quintile. This underscores the need for individualised and targeted interventions that consider the deprivation of communities where people live.