The Prevalence and Associated Factors of Cancer Screening Uptake Among a National Population-Based Sample of Adults in Marshall Islands

Background: The study aimed to estimate the prevalence and associated factors of cancer screening among men and women in the general population in Marshall Islands. Methods: The national cross-sectional sub-study population consisted of 2,813 persons aged 21-75 years (Median = 37.4 years) from the “2017/2018 Marshall Islands STEPS survey”. Information about cancer screening uptake included Pap smear or Vaginal Inspection with Acetic Acid (=VIA), clinical breast examination, mammography, faecal occult blood test (FOBT), and colonoscopy. Results: The prevalence of past 2 years mammography screening was 21.7% among women aged 50-74 years, past year CBE 15.9% among women aged 40 years and older, past 3 years Pap smear or VIA 32.6% among women 21-65 years, past year FOBT 21.8% among women and 22.3% among men aged 50-75 years, and past 10 years colonoscopy 9.1% among women and 7.3% among men aged 50-75 years. In adjusted logistic regression, cholesterol screening (AOR: 1.91, 95% CI: 1.07-3.41) was associated with past 2 years mammography screening among women aged 50-74 years. Blood pressure screening (AOR: 2.39, 95% CI: 1.71-3.35), glucose screening (AOR: 1.59, 95% CI: 1.13-2.23), dental visit in the past year (AOR: 1.51, 95% CI: 1.17, 1.96), binge drinking (AOR: 1.88, 95% CI: 1.07-3.30), and 2-3 servings of fruit and vegetable consumption a day (AOR: 1.42, 95% CI: 1.03-1.95) were positively and high physical activity (30 days a month) (AOR: 0.56, 95% CI: 0.41-0.76) was negatively associated with Pap smear or VIA screening among women aged 21-65 years. Higher education (AOR: 2.58, 95% CI: 1.02-6.58), and cholesterol screening (AOR: 2.87, 95% CI: 1.48-5.59), were positively and current smoking (AOR: 0.09, 95% CI: 0.01-0.65) was negatively associated with past 10 years colonoscopy uptake among 50-75 year-olds. Conclusion: The study showed a low cancer screening uptake, and several factors were identified that can assist in promoting cancer screening in Marshall Islands.

Abstract 14052: Differences in Pediatric Cholesterol Screening Rates Between Family Medicine and Pediatrics Correlate With Conflicting Guidelines

Introduction: In 2011, the National Heart, Lung, and Blood Institute released pediatric cardiovascular guidelines, recommending universal cholesterol screening between ages 9-11 and 17-21 years. This guideline conflicts with other organizations, notably the 2016 United States Preventative Services Task Force (USPSTF) statement which did not endorse universal screening. Our institution has utilized educational tools and electronic health record (EHR) modifications to encourage pediatric cholesterol screening. Hypothesis: Changes in pediatric lipid screening rates within a single institution correlate with release of national guidelines, as well as local educational tools and EHR modifications. Methods: Order placement was defined as ordering a high-density lipoprotein cholesterol level in a patient 9-21 years with ≥ 1 well visit in prior 3 years. Order placement rate (OPR) was calculated per month using 3 months’ moving average smoothing and analyzed based on date and specialty of ordering clinician. Timing of educational tools, EHR modifications, and national guideline release were analyzed for changes in OPR. Results: A total of 36,756 visits from 2010-2019 with 21,239 orders were analyzed. Total OPR was 57.8%. Prior to 2011 guideline, pediatrician (P) OPR was 41% (95% CI: 36-47%) and 9% (7-10%) for family medicine (FM). OPR increased in the 12 months after 2011 guideline, educational initiatives, and EHR changes for P (80%, 95% CI: 76-83%) and FM (21%, 95% CI: 19-25%) . Both P and FM had lower rates after 2016, with greater decrease for FM (p<0.001 for all). Conclusions: OPR was higher in P than FM, with largest OPR changes correlating with release of guidelines. Larger positive changes in OPR were seen in P compared to FM after 2011 guideline, and larger decrease in OPR in FM compared to P correlating with 2016 USPSTF statement release. Conflicting guidelines may contribute to lower overall OPR as well as different screening rates for children cared for by P and FM.