Edited by Joseph Garces

Women with epithelial ovarian cancer treated in the US Department of Defense (DoD) universal health care system demonstrate better 5-year survival compared with similar patients from the national population. The survival advantage persists across multiple age groups and disease stages, with particularly notable improvements in patients aged 35-49 years and those with stage III disease.

METHODOLOGY:

• Researchers compared 1504 patients with invasive stage I-IV epithelial ovarian carcinoma from the Automated Center Tumor Registry (ACTUR) for the DoD with 6016 matched patients from the 18-region Surveillance, Epidemiology, and End Results (SEER) program between 1987 and 2013.
• Patients from ACTUR were matched in a 1:4 ratio with SEER patients stratified for age, race, year of diagnosis, and histology, including serous carcinoma, clear cell carcinoma, mucinous carcinoma, and endometrioid carcinoma with adenocarcinoma subtypes.
• Five-year overall survival was evaluated using the Kaplan-Meier method and compared using log-rank test, with median follow-up time of 46 months in ACTUR and 44 months in SEER.
• Adjusted hazard ratio (AHR) and 95% CI for all-cause mortality were estimated from multivariable Cox proportional regression modeling controlling for age, race, year of diagnosis, region of diagnosis, stage, histology, and grade.

TAKEAWAY:

• Overall survival differs between registries: 5-year survival of 53.2% in ACTUR vs 47.7% in matched SEER cohort (log-rank P = .001).
• In the primary adjusted model, ACTUR is associated with a lower risk for all-cause mortality vs SEER (AHR, 0.83; 95% CI, 0.76-0.91; P < .0001).
• Subset results retain lower adjusted risk for death for ACTUR vs SEER among ages 35-49 years (AHR, 0.66; 95% CI, 0.52-0.83; P = .0005), ages ≥ 65 years (AHR, 0.82; 95% CI, 0.70-0.96; P = .016), and stage III cancer (AHR, 0.79; 95% CI, 0.69-0.91; P = .0015).
• Histology-stratified findings show lower adjusted risk for death in ACTUR vs SEER for clear cell carcinoma (AHR, 0.63; 95% CI, 0.43-0.93; P =.02) and for endometrioid and other adenocarcinomas (AHR, 0.68; 95% CI, 0.56-0.81; P < .0001).

IN PRACTICE:

"This study is envisioned to be a stepping stone to further investigations of survival and other cancer health outcomes starting with patients diagnosed between 2014 and 2024 with epithelial carcinoma of the ovary, fallopian tube, or primary peritoneum in the DoD Healthcare System versus the national population or other Healthcare Systems,” wrote the authors of the study. “Dedicated funding and support in the [Military Health System] are needed to invest in infrastructure, technology, security, education, and research.”

SOURCE:

The study was led by Kathleen M. Darcy, PhD, and Christopher M. Tarney, MD, from the Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery & Obstetrics, Uniformed Services University, Walter Reed National Military Medical Center in Bethesda, Maryland. It was published online in Military Medicine.

LIMITATIONS:

The retrospective cohort study design limits causal inference. Although groups were balanced by age, race, year, and region of diagnosis, other demographic factors and socioeconomic variables such as patient comorbidities, educational attainment, household income, and health insurance status were not available and may have affected results. The databases fundamentally differ in how data are acquired, with ACTUR following hospital-based Facility Oncology Registry Data Standards and SEER being a national population-based registry, potentially affecting data quality, consistency, and reliability of survival outcome comparisons. The inclusion of patients diagnosed only through 2013 represents a limitation as it does not allow for contemporary evaluation of survival outcomes, particularly given advances over the past decade including maximal cytoreductive effort to no residual disease, increased adoption of neoadjuvant chemotherapy, and introduction of targeted maintenance agents. The study could not incorporate details regarding residual disease status or control for specifics regarding surgical and medical management, including primary vs interval debulking surgery or the type and timing of agents utilized in first-line, maintenance, and recurrent disease settings. Data regarding circulating biomarkers including CA125, molecular subtypes or alterations, and stratification by homologous recombination deficiency vs proficiency status were not available. Epithelial carcinomas of the fallopian tube and primary peritoneum were excluded from this study, which now are commonly incorporated with ovarian carcinomas. Results may not be generalizable to other populations given the unique characteristics of the Military Health System beneficiary population.

DISCLOSURES:

This research received funding from the Uniformed Services University from the Defense Health Program to the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., including award HU0001-18-2-0032 to the Murtha Cancer Center Research Program and awards HU0001-19-2-0031 and HU0001-24-2-0047 to the Gynecologic Cancer Center of Excellence Program. All coauthors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Women with epithelial ovarian cancer treated in the US Department of Defense (DoD) universal health care system demonstrate better 5-year survival compared with similar patients from the national population. The survival advantage persists across multiple age groups and disease stages, with particularly notable improvements in patients aged 35-49 years and those with stage III disease.

METHODOLOGY:

• Researchers compared 1504 patients with invasive stage I-IV epithelial ovarian carcinoma from the Automated Center Tumor Registry (ACTUR) for the DoD with 6016 matched patients from the 18-region Surveillance, Epidemiology, and End Results (SEER) program between 1987 and 2013.
• Patients from ACTUR were matched in a 1:4 ratio with SEER patients stratified for age, race, year of diagnosis, and histology, including serous carcinoma, clear cell carcinoma, mucinous carcinoma, and endometrioid carcinoma with adenocarcinoma subtypes.
• Five-year overall survival was evaluated using the Kaplan-Meier method and compared using log-rank test, with median follow-up time of 46 months in ACTUR and 44 months in SEER.
• Adjusted hazard ratio (AHR) and 95% CI for all-cause mortality were estimated from multivariable Cox proportional regression modeling controlling for age, race, year of diagnosis, region of diagnosis, stage, histology, and grade.

TAKEAWAY:

• Overall survival differs between registries: 5-year survival of 53.2% in ACTUR vs 47.7% in matched SEER cohort (log-rank P = .001).
• In the primary adjusted model, ACTUR is associated with a lower risk for all-cause mortality vs SEER (AHR, 0.83; 95% CI, 0.76-0.91; P < .0001).
• Subset results retain lower adjusted risk for death for ACTUR vs SEER among ages 35-49 years (AHR, 0.66; 95% CI, 0.52-0.83; P = .0005), ages ≥ 65 years (AHR, 0.82; 95% CI, 0.70-0.96; P = .016), and stage III cancer (AHR, 0.79; 95% CI, 0.69-0.91; P = .0015).
• Histology-stratified findings show lower adjusted risk for death in ACTUR vs SEER for clear cell carcinoma (AHR, 0.63; 95% CI, 0.43-0.93; P =.02) and for endometrioid and other adenocarcinomas (AHR, 0.68; 95% CI, 0.56-0.81; P < .0001).

IN PRACTICE:

"This study is envisioned to be a stepping stone to further investigations of survival and other cancer health outcomes starting with patients diagnosed between 2014 and 2024 with epithelial carcinoma of the ovary, fallopian tube, or primary peritoneum in the DoD Healthcare System versus the national population or other Healthcare Systems,” wrote the authors of the study. “Dedicated funding and support in the [Military Health System] are needed to invest in infrastructure, technology, security, education, and research.”

SOURCE:

The study was led by Kathleen M. Darcy, PhD, and Christopher M. Tarney, MD, from the Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery & Obstetrics, Uniformed Services University, Walter Reed National Military Medical Center in Bethesda, Maryland. It was published online in Military Medicine.

LIMITATIONS:

The retrospective cohort study design limits causal inference. Although groups were balanced by age, race, year, and region of diagnosis, other demographic factors and socioeconomic variables such as patient comorbidities, educational attainment, household income, and health insurance status were not available and may have affected results. The databases fundamentally differ in how data are acquired, with ACTUR following hospital-based Facility Oncology Registry Data Standards and SEER being a national population-based registry, potentially affecting data quality, consistency, and reliability of survival outcome comparisons. The inclusion of patients diagnosed only through 2013 represents a limitation as it does not allow for contemporary evaluation of survival outcomes, particularly given advances over the past decade including maximal cytoreductive effort to no residual disease, increased adoption of neoadjuvant chemotherapy, and introduction of targeted maintenance agents. The study could not incorporate details regarding residual disease status or control for specifics regarding surgical and medical management, including primary vs interval debulking surgery or the type and timing of agents utilized in first-line, maintenance, and recurrent disease settings. Data regarding circulating biomarkers including CA125, molecular subtypes or alterations, and stratification by homologous recombination deficiency vs proficiency status were not available. Epithelial carcinomas of the fallopian tube and primary peritoneum were excluded from this study, which now are commonly incorporated with ovarian carcinomas. Results may not be generalizable to other populations given the unique characteristics of the Military Health System beneficiary population.

DISCLOSURES:

This research received funding from the Uniformed Services University from the Defense Health Program to the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., including award HU0001-18-2-0032 to the Murtha Cancer Center Research Program and awards HU0001-19-2-0031 and HU0001-24-2-0047 to the Gynecologic Cancer Center of Excellence Program. All coauthors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Women with epithelial ovarian cancer treated in the US Department of Defense (DoD) universal health care system demonstrate better 5-year survival compared with similar patients from the national population. The survival advantage persists across multiple age groups and disease stages, with particularly notable improvements in patients aged 35-49 years and those with stage III disease.

METHODOLOGY:

• Researchers compared 1504 patients with invasive stage I-IV epithelial ovarian carcinoma from the Automated Center Tumor Registry (ACTUR) for the DoD with 6016 matched patients from the 18-region Surveillance, Epidemiology, and End Results (SEER) program between 1987 and 2013.
• Patients from ACTUR were matched in a 1:4 ratio with SEER patients stratified for age, race, year of diagnosis, and histology, including serous carcinoma, clear cell carcinoma, mucinous carcinoma, and endometrioid carcinoma with adenocarcinoma subtypes.
• Five-year overall survival was evaluated using the Kaplan-Meier method and compared using log-rank test, with median follow-up time of 46 months in ACTUR and 44 months in SEER.
• Adjusted hazard ratio (AHR) and 95% CI for all-cause mortality were estimated from multivariable Cox proportional regression modeling controlling for age, race, year of diagnosis, region of diagnosis, stage, histology, and grade.

TAKEAWAY:

• Overall survival differs between registries: 5-year survival of 53.2% in ACTUR vs 47.7% in matched SEER cohort (log-rank P = .001).
• In the primary adjusted model, ACTUR is associated with a lower risk for all-cause mortality vs SEER (AHR, 0.83; 95% CI, 0.76-0.91; P < .0001).
• Subset results retain lower adjusted risk for death for ACTUR vs SEER among ages 35-49 years (AHR, 0.66; 95% CI, 0.52-0.83; P = .0005), ages ≥ 65 years (AHR, 0.82; 95% CI, 0.70-0.96; P = .016), and stage III cancer (AHR, 0.79; 95% CI, 0.69-0.91; P = .0015).
• Histology-stratified findings show lower adjusted risk for death in ACTUR vs SEER for clear cell carcinoma (AHR, 0.63; 95% CI, 0.43-0.93; P =.02) and for endometrioid and other adenocarcinomas (AHR, 0.68; 95% CI, 0.56-0.81; P < .0001).

IN PRACTICE:

"This study is envisioned to be a stepping stone to further investigations of survival and other cancer health outcomes starting with patients diagnosed between 2014 and 2024 with epithelial carcinoma of the ovary, fallopian tube, or primary peritoneum in the DoD Healthcare System versus the national population or other Healthcare Systems,” wrote the authors of the study. “Dedicated funding and support in the [Military Health System] are needed to invest in infrastructure, technology, security, education, and research.”

SOURCE:

The study was led by Kathleen M. Darcy, PhD, and Christopher M. Tarney, MD, from the Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery & Obstetrics, Uniformed Services University, Walter Reed National Military Medical Center in Bethesda, Maryland. It was published online in Military Medicine.

LIMITATIONS:

The retrospective cohort study design limits causal inference. Although groups were balanced by age, race, year, and region of diagnosis, other demographic factors and socioeconomic variables such as patient comorbidities, educational attainment, household income, and health insurance status were not available and may have affected results. The databases fundamentally differ in how data are acquired, with ACTUR following hospital-based Facility Oncology Registry Data Standards and SEER being a national population-based registry, potentially affecting data quality, consistency, and reliability of survival outcome comparisons. The inclusion of patients diagnosed only through 2013 represents a limitation as it does not allow for contemporary evaluation of survival outcomes, particularly given advances over the past decade including maximal cytoreductive effort to no residual disease, increased adoption of neoadjuvant chemotherapy, and introduction of targeted maintenance agents. The study could not incorporate details regarding residual disease status or control for specifics regarding surgical and medical management, including primary vs interval debulking surgery or the type and timing of agents utilized in first-line, maintenance, and recurrent disease settings. Data regarding circulating biomarkers including CA125, molecular subtypes or alterations, and stratification by homologous recombination deficiency vs proficiency status were not available. Epithelial carcinomas of the fallopian tube and primary peritoneum were excluded from this study, which now are commonly incorporated with ovarian carcinomas. Results may not be generalizable to other populations given the unique characteristics of the Military Health System beneficiary population.

DISCLOSURES:

This research received funding from the Uniformed Services University from the Defense Health Program to the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., including award HU0001-18-2-0032 to the Murtha Cancer Center Research Program and awards HU0001-19-2-0031 and HU0001-24-2-0047 to the Gynecologic Cancer Center of Excellence Program. All coauthors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: In 75,453 veterans with head and neck squamous cell carcinoma (HNSCC), 36.4% live in rural or highly rural areas and 32.0% have a national area deprivation index (ADI) ≥ 75. The average drive time to the nearest tertiary or complex US Department of Veterans Affairs (VA) facility is 94 minutes, highlighting potential access and equity barriers related to rurality, deprivation, and distance.

METHODOLOGY:

• A retrospective descriptive study using nationwide VA data from fiscal years 2012 to 2022 identified 75,453 veterans with head and neck squamous cell carcinoma (HNSCC) by International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes.

• Patients were grouped into 5 primary tumor subsites: oral cavity, oropharynx, hypopharynx, larynx, and nasopharynx.

• Rurality was classified using Rural-Urban Commuting Area-derived urban, rural, and highly rural scores; socioeconomic disadvantage was measured with national ADI scores.

• Travel burden was assessed using time and distance to the nearest primary, secondary, and tertiary VA facilities.

TAKEAWAY:

• Oropharyngeal cancer (OPC) cases among veterans increased from 26.3% in 2012 to 46.0% in 2022, while laryngeal cancers decreased from 41.2% to 29.3%.

• HNSCCs locations included 35.6% in the larynx, 34.4% in the oropharynx, 22.6% in the oral cavity 3.7% in the hypopharynx, and 3.7% in the nasopharynx.

• Veterans with OPC were younger than non-OPC patients and more likely to be White; > 70% were current or former smokers.

IN PRACTICE: “Understanding the geographic and socioeconomic landscape of veterans with HNSCC will allow us to tease out the factors associated with poor outcomes and ultimately design interventions that target high-risk veteran populations to improve overall health outcomes,” the authors argued.

SOURCE: The study was led by researchers at the Veterans Affairs Pittsburgh Healthcare System. It was published online in Head & Neck.

LIMITATIONS: The inability to extract accurate data from a large dataset, challenges in obtaining tumor stage information due to varying documentation practices across physicians and treatment courses, and the inability to assess HPV or p16 data for the cohort represents significant limitations that may have impacted interpretation of results. Clinical outcome measures and cause of death assessment were limited in this national database, affecting the ability to draw conclusions regarding the impact of rurality, area deprivation, and travel time on outcomes.

DISCLOSURES: Chad Brenner reported holding several patents related to the development and use of circulating tumor DNA tests in patients with HNSCC. Jose P. Zevallos disclosed being the founder, equity shareholder, and board member of Droplet Biosciences and Echogenesis Therapeutics, serving as chief scientific advisor and shareholder of Vine Medical, and acting as a consultant for Merck and Johnson & Johnson. Matthew E. Spector reported serving as a consultant for Hologic. Kristen L. Zayan, Jennifer L. McCoy, Monique Y. Boudreaux-Kelly, Zachary Hahn, John Hotchkiss, and Jessica H. Maxwell declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: In 75,453 veterans with head and neck squamous cell carcinoma (HNSCC), 36.4% live in rural or highly rural areas and 32.0% have a national area deprivation index (ADI) ≥ 75. The average drive time to the nearest tertiary or complex US Department of Veterans Affairs (VA) facility is 94 minutes, highlighting potential access and equity barriers related to rurality, deprivation, and distance.

METHODOLOGY:

• A retrospective descriptive study using nationwide VA data from fiscal years 2012 to 2022 identified 75,453 veterans with head and neck squamous cell carcinoma (HNSCC) by International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes.

• Patients were grouped into 5 primary tumor subsites: oral cavity, oropharynx, hypopharynx, larynx, and nasopharynx.

• Rurality was classified using Rural-Urban Commuting Area-derived urban, rural, and highly rural scores; socioeconomic disadvantage was measured with national ADI scores.

• Travel burden was assessed using time and distance to the nearest primary, secondary, and tertiary VA facilities.

TAKEAWAY:

• Oropharyngeal cancer (OPC) cases among veterans increased from 26.3% in 2012 to 46.0% in 2022, while laryngeal cancers decreased from 41.2% to 29.3%.

• HNSCCs locations included 35.6% in the larynx, 34.4% in the oropharynx, 22.6% in the oral cavity 3.7% in the hypopharynx, and 3.7% in the nasopharynx.

• Veterans with OPC were younger than non-OPC patients and more likely to be White; > 70% were current or former smokers.

IN PRACTICE: “Understanding the geographic and socioeconomic landscape of veterans with HNSCC will allow us to tease out the factors associated with poor outcomes and ultimately design interventions that target high-risk veteran populations to improve overall health outcomes,” the authors argued.

SOURCE: The study was led by researchers at the Veterans Affairs Pittsburgh Healthcare System. It was published online in Head & Neck.

LIMITATIONS: The inability to extract accurate data from a large dataset, challenges in obtaining tumor stage information due to varying documentation practices across physicians and treatment courses, and the inability to assess HPV or p16 data for the cohort represents significant limitations that may have impacted interpretation of results. Clinical outcome measures and cause of death assessment were limited in this national database, affecting the ability to draw conclusions regarding the impact of rurality, area deprivation, and travel time on outcomes.

DISCLOSURES: Chad Brenner reported holding several patents related to the development and use of circulating tumor DNA tests in patients with HNSCC. Jose P. Zevallos disclosed being the founder, equity shareholder, and board member of Droplet Biosciences and Echogenesis Therapeutics, serving as chief scientific advisor and shareholder of Vine Medical, and acting as a consultant for Merck and Johnson & Johnson. Matthew E. Spector reported serving as a consultant for Hologic. Kristen L. Zayan, Jennifer L. McCoy, Monique Y. Boudreaux-Kelly, Zachary Hahn, John Hotchkiss, and Jessica H. Maxwell declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: In 75,453 veterans with head and neck squamous cell carcinoma (HNSCC), 36.4% live in rural or highly rural areas and 32.0% have a national area deprivation index (ADI) ≥ 75. The average drive time to the nearest tertiary or complex US Department of Veterans Affairs (VA) facility is 94 minutes, highlighting potential access and equity barriers related to rurality, deprivation, and distance.

METHODOLOGY:

• A retrospective descriptive study using nationwide VA data from fiscal years 2012 to 2022 identified 75,453 veterans with head and neck squamous cell carcinoma (HNSCC) by International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes.

• Patients were grouped into 5 primary tumor subsites: oral cavity, oropharynx, hypopharynx, larynx, and nasopharynx.

• Rurality was classified using Rural-Urban Commuting Area-derived urban, rural, and highly rural scores; socioeconomic disadvantage was measured with national ADI scores.

• Travel burden was assessed using time and distance to the nearest primary, secondary, and tertiary VA facilities.

TAKEAWAY:

• Oropharyngeal cancer (OPC) cases among veterans increased from 26.3% in 2012 to 46.0% in 2022, while laryngeal cancers decreased from 41.2% to 29.3%.

• HNSCCs locations included 35.6% in the larynx, 34.4% in the oropharynx, 22.6% in the oral cavity 3.7% in the hypopharynx, and 3.7% in the nasopharynx.

• Veterans with OPC were younger than non-OPC patients and more likely to be White; > 70% were current or former smokers.

IN PRACTICE: “Understanding the geographic and socioeconomic landscape of veterans with HNSCC will allow us to tease out the factors associated with poor outcomes and ultimately design interventions that target high-risk veteran populations to improve overall health outcomes,” the authors argued.

SOURCE: The study was led by researchers at the Veterans Affairs Pittsburgh Healthcare System. It was published online in Head & Neck.

LIMITATIONS: The inability to extract accurate data from a large dataset, challenges in obtaining tumor stage information due to varying documentation practices across physicians and treatment courses, and the inability to assess HPV or p16 data for the cohort represents significant limitations that may have impacted interpretation of results. Clinical outcome measures and cause of death assessment were limited in this national database, affecting the ability to draw conclusions regarding the impact of rurality, area deprivation, and travel time on outcomes.

DISCLOSURES: Chad Brenner reported holding several patents related to the development and use of circulating tumor DNA tests in patients with HNSCC. Jose P. Zevallos disclosed being the founder, equity shareholder, and board member of Droplet Biosciences and Echogenesis Therapeutics, serving as chief scientific advisor and shareholder of Vine Medical, and acting as a consultant for Merck and Johnson & Johnson. Matthew E. Spector reported serving as a consultant for Hologic. Kristen L. Zayan, Jennifer L. McCoy, Monique Y. Boudreaux-Kelly, Zachary Hahn, John Hotchkiss, and Jessica H. Maxwell declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Among 1.3 million male veterans treated for prostate cancer, 11,327 (0.86%) developed breast cancer an average of 5.4 years after initial diagnosis. Younger age at prostate cancer diagnosis, metastatic disease, androgen deprivation therapy (ADT), radiation treatment, and prolonged use of certain cardiovascular disease (CVD) medications were associated with increased risk for breast cancer.

METHODOLOGY:

• Researchers used a retrospective cohort design in Veterans Health Administration (VHA) care, pulling data from the Veterans Affairs (VA) Prostate Cancer Data Core at the VA Corporate Data Warehouse.
• Participants included 1,314,492 male veterans with prostate cancer treated at VHA facilities from January 1, 2000, to March 12, 2024.
• Exposure definitions included prostate cancer treatments (ADT, anti-androgen treatment, radiation-brachytherapy, and platinum chemotherapy) and CVD medications (furosemide, spironolactone, digoxin) captured via inpatient/outpatient/fee-based pharmacy and Current Procedural Terminology codes.
• Analysis measured time from prostate cancer diagnosis to breast cancer diagnosis, death, or March 12, 2024, applying Cox proportional hazards and Fine-Gray competing risk methods, with a sensitivity analysis adding body mass index (BMI) after excluding 71,718 missing values.

TAKEAWAY:

• Metastatic prostate cancer at diagnosis more than doubled the risk for breast cancer compared to nonmetastatic disease (hazard ratio [HR], 2.03; 95% CI, 1.90-2.17; P < .0001; subdistribution hazard ratio [SHR], 1.68; 95% CI, 1.57-1.81; P < .0001).
• Younger age at prostate cancer diagnosis was associated with increased risk for breast cancer (HR, 0.97; 95% CI, 0.97-0.98; P < .0001; SHR, 0.957; 95% CI, 0.955-0.959; P < .0001), indicating that for each additional year of age at diagnosis, the risk decreased.
• Continuation of CVD medications after prostate cancer diagnosis was associated with increased risk for breast cancer: furosemide (HR, 1.51; 95% CI, 1.39-1.63; P < .0001; SHR, 1.21; 95% CI, 1.12-1.31; P < .0001), spironolactone (HR, 1.36; 95% CI, 1.15-1.61; P = .0004; SHR, 1.23; 95% CI, 1.04-1.47; P = .0174), and digoxin (HR, 1.49; 95% CI, 1.29-1.72; P < .0001; SHR, 1.26; 95% CI, 1.10-1.46; P = .0015).
• Radiation therapy and ADT were associated with increased risk for breast cancer (radiation: HR, 1.06; 95% CI, 1.02-1.11; P = .0088; SHR, 1.10; 95% CI, 1.05-1.15; P < .0001; ADT: HR, 1.24; 95% CI, 1.17-1.32; P < .0001; SHR, 1.28; 95% CI, 1.20-1.37; P < .0001), while abiraterone was associated with decreased risk (HR, 0.36; 95% CI, 0.31-0.42; P < .0001; SHR, 0.39; 95% CI, 0.34-0.45; P < .0001).

IN PRACTICE:

"While there is a lack of data, male veterans with previous prostate cancer are at an elevated risk of breast cancer (0.87%), than their civilian counterparts (0.14%),” the authors wrote. “To address the current gap in knowledge and data, this study leveraged an existing large cohort of male veterans with prostate cancer and examined factors associated with increased risk of male breast cancer."

SOURCE:

The study was led by Erum Z. Whyne, VA North Texas Health Care System in Dallas, and Haekyung Jeon-Slaughter, University of Texas Southwestern Medical Center in Dallas. It was published online in The Prostate.

LIMITATIONS:

Though the study findings are based on large, representative data from male veterans with previously diagnosed prostate cancer, the results might not be generalizable to the overall male breast cancer population. As a retrospective cohort study, results may be biased and causality is difficult to establish. The study did not examine other known risk factors for male breast cancer incidence, such as family history, BRCA2 mutations, and military environmental exposure due to lack of data. BMI had missingness of 5.46% (n = 71,718) and was not included as a covariate in the final model, though sensitivity analysis showed it was not significantly associated with increased risk for male breast cancer.

DISCLOSURES:

The research was supported using resources and facilities of the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. The VA North Texas Health Care System Institutional Review Board approved the study and waived informed consent. No conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Among 1.3 million male veterans treated for prostate cancer, 11,327 (0.86%) developed breast cancer an average of 5.4 years after initial diagnosis. Younger age at prostate cancer diagnosis, metastatic disease, androgen deprivation therapy (ADT), radiation treatment, and prolonged use of certain cardiovascular disease (CVD) medications were associated with increased risk for breast cancer.

METHODOLOGY:

• Researchers used a retrospective cohort design in Veterans Health Administration (VHA) care, pulling data from the Veterans Affairs (VA) Prostate Cancer Data Core at the VA Corporate Data Warehouse.
• Participants included 1,314,492 male veterans with prostate cancer treated at VHA facilities from January 1, 2000, to March 12, 2024.
• Exposure definitions included prostate cancer treatments (ADT, anti-androgen treatment, radiation-brachytherapy, and platinum chemotherapy) and CVD medications (furosemide, spironolactone, digoxin) captured via inpatient/outpatient/fee-based pharmacy and Current Procedural Terminology codes.
• Analysis measured time from prostate cancer diagnosis to breast cancer diagnosis, death, or March 12, 2024, applying Cox proportional hazards and Fine-Gray competing risk methods, with a sensitivity analysis adding body mass index (BMI) after excluding 71,718 missing values.

TAKEAWAY:

• Metastatic prostate cancer at diagnosis more than doubled the risk for breast cancer compared to nonmetastatic disease (hazard ratio [HR], 2.03; 95% CI, 1.90-2.17; P < .0001; subdistribution hazard ratio [SHR], 1.68; 95% CI, 1.57-1.81; P < .0001).
• Younger age at prostate cancer diagnosis was associated with increased risk for breast cancer (HR, 0.97; 95% CI, 0.97-0.98; P < .0001; SHR, 0.957; 95% CI, 0.955-0.959; P < .0001), indicating that for each additional year of age at diagnosis, the risk decreased.
• Continuation of CVD medications after prostate cancer diagnosis was associated with increased risk for breast cancer: furosemide (HR, 1.51; 95% CI, 1.39-1.63; P < .0001; SHR, 1.21; 95% CI, 1.12-1.31; P < .0001), spironolactone (HR, 1.36; 95% CI, 1.15-1.61; P = .0004; SHR, 1.23; 95% CI, 1.04-1.47; P = .0174), and digoxin (HR, 1.49; 95% CI, 1.29-1.72; P < .0001; SHR, 1.26; 95% CI, 1.10-1.46; P = .0015).
• Radiation therapy and ADT were associated with increased risk for breast cancer (radiation: HR, 1.06; 95% CI, 1.02-1.11; P = .0088; SHR, 1.10; 95% CI, 1.05-1.15; P < .0001; ADT: HR, 1.24; 95% CI, 1.17-1.32; P < .0001; SHR, 1.28; 95% CI, 1.20-1.37; P < .0001), while abiraterone was associated with decreased risk (HR, 0.36; 95% CI, 0.31-0.42; P < .0001; SHR, 0.39; 95% CI, 0.34-0.45; P < .0001).

IN PRACTICE:

"While there is a lack of data, male veterans with previous prostate cancer are at an elevated risk of breast cancer (0.87%), than their civilian counterparts (0.14%),” the authors wrote. “To address the current gap in knowledge and data, this study leveraged an existing large cohort of male veterans with prostate cancer and examined factors associated with increased risk of male breast cancer."

SOURCE:

The study was led by Erum Z. Whyne, VA North Texas Health Care System in Dallas, and Haekyung Jeon-Slaughter, University of Texas Southwestern Medical Center in Dallas. It was published online in The Prostate.

LIMITATIONS:

Though the study findings are based on large, representative data from male veterans with previously diagnosed prostate cancer, the results might not be generalizable to the overall male breast cancer population. As a retrospective cohort study, results may be biased and causality is difficult to establish. The study did not examine other known risk factors for male breast cancer incidence, such as family history, BRCA2 mutations, and military environmental exposure due to lack of data. BMI had missingness of 5.46% (n = 71,718) and was not included as a covariate in the final model, though sensitivity analysis showed it was not significantly associated with increased risk for male breast cancer.

DISCLOSURES:

The research was supported using resources and facilities of the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. The VA North Texas Health Care System Institutional Review Board approved the study and waived informed consent. No conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Among 1.3 million male veterans treated for prostate cancer, 11,327 (0.86%) developed breast cancer an average of 5.4 years after initial diagnosis. Younger age at prostate cancer diagnosis, metastatic disease, androgen deprivation therapy (ADT), radiation treatment, and prolonged use of certain cardiovascular disease (CVD) medications were associated with increased risk for breast cancer.

METHODOLOGY:

• Researchers used a retrospective cohort design in Veterans Health Administration (VHA) care, pulling data from the Veterans Affairs (VA) Prostate Cancer Data Core at the VA Corporate Data Warehouse.
• Participants included 1,314,492 male veterans with prostate cancer treated at VHA facilities from January 1, 2000, to March 12, 2024.
• Exposure definitions included prostate cancer treatments (ADT, anti-androgen treatment, radiation-brachytherapy, and platinum chemotherapy) and CVD medications (furosemide, spironolactone, digoxin) captured via inpatient/outpatient/fee-based pharmacy and Current Procedural Terminology codes.
• Analysis measured time from prostate cancer diagnosis to breast cancer diagnosis, death, or March 12, 2024, applying Cox proportional hazards and Fine-Gray competing risk methods, with a sensitivity analysis adding body mass index (BMI) after excluding 71,718 missing values.

TAKEAWAY:

• Metastatic prostate cancer at diagnosis more than doubled the risk for breast cancer compared to nonmetastatic disease (hazard ratio [HR], 2.03; 95% CI, 1.90-2.17; P < .0001; subdistribution hazard ratio [SHR], 1.68; 95% CI, 1.57-1.81; P < .0001).
• Younger age at prostate cancer diagnosis was associated with increased risk for breast cancer (HR, 0.97; 95% CI, 0.97-0.98; P < .0001; SHR, 0.957; 95% CI, 0.955-0.959; P < .0001), indicating that for each additional year of age at diagnosis, the risk decreased.
• Continuation of CVD medications after prostate cancer diagnosis was associated with increased risk for breast cancer: furosemide (HR, 1.51; 95% CI, 1.39-1.63; P < .0001; SHR, 1.21; 95% CI, 1.12-1.31; P < .0001), spironolactone (HR, 1.36; 95% CI, 1.15-1.61; P = .0004; SHR, 1.23; 95% CI, 1.04-1.47; P = .0174), and digoxin (HR, 1.49; 95% CI, 1.29-1.72; P < .0001; SHR, 1.26; 95% CI, 1.10-1.46; P = .0015).
• Radiation therapy and ADT were associated with increased risk for breast cancer (radiation: HR, 1.06; 95% CI, 1.02-1.11; P = .0088; SHR, 1.10; 95% CI, 1.05-1.15; P < .0001; ADT: HR, 1.24; 95% CI, 1.17-1.32; P < .0001; SHR, 1.28; 95% CI, 1.20-1.37; P < .0001), while abiraterone was associated with decreased risk (HR, 0.36; 95% CI, 0.31-0.42; P < .0001; SHR, 0.39; 95% CI, 0.34-0.45; P < .0001).

IN PRACTICE:

"While there is a lack of data, male veterans with previous prostate cancer are at an elevated risk of breast cancer (0.87%), than their civilian counterparts (0.14%),” the authors wrote. “To address the current gap in knowledge and data, this study leveraged an existing large cohort of male veterans with prostate cancer and examined factors associated with increased risk of male breast cancer."

SOURCE:

The study was led by Erum Z. Whyne, VA North Texas Health Care System in Dallas, and Haekyung Jeon-Slaughter, University of Texas Southwestern Medical Center in Dallas. It was published online in The Prostate.

LIMITATIONS:

Though the study findings are based on large, representative data from male veterans with previously diagnosed prostate cancer, the results might not be generalizable to the overall male breast cancer population. As a retrospective cohort study, results may be biased and causality is difficult to establish. The study did not examine other known risk factors for male breast cancer incidence, such as family history, BRCA2 mutations, and military environmental exposure due to lack of data. BMI had missingness of 5.46% (n = 71,718) and was not included as a covariate in the final model, though sensitivity analysis showed it was not significantly associated with increased risk for male breast cancer.

DISCLOSURES:

The research was supported using resources and facilities of the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. The VA North Texas Health Care System Institutional Review Board approved the study and waived informed consent. No conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

More than 1 in 8 colorectal cancer (CRC) cases among veterans occur outside the standard screening age of 50-75 years or those with high-risk personal or family history. High-risk patients face > 6 times the risk for CRC compared with average-risk patients aged 50-75 years who are up to date with screening, while Black patients have > 50% higher risk compared with White patients.

METHODOLOGY:

• Researchers conducted a case-control analysis using Veterans Health Administration (VHA) Corporate Data Warehouse data from 2012-2018 at 2 sites: Veterans Affairs (VA) New York Harbor Health Care System and VA Puget Sound Health Care System.

• Participants included 3714 cases among veterans with CRC matched to 14,856 controls (4:1), with matching on age (± 3 years), sex, and facility site; each control was used once.

• Screening categories included 5 groups by age (50-75 years vs < 50 years or > 75 years), screening up-to-date status, and high-risk status (inflammatory bowel disease, hereditary cancer syndromes, or family history).

• CRC screening was considered up to date if US Preventive Services Task Force-recommended tests were completed on time (colonoscopy ≤ 10 years; guaiac-based fecal occult blood test or fecal immunochemical test ≤ 1 year).

TAKEAWAY:

• Compared with category 1 (age 50-75 years and up-to-date with screening), CRC was associated with category 4 (age < 50 years or > 75 years and not up to date) (odds ratio [OR], 1.40; 95% CI, 1.11-1.78), and category 5 (high risk) (OR, 6.23; 95% CI, 5.06-7.66).

• Race and comorbidity associations included higher CRC risk for Black vs White patients (OR, 1.54; 95% CI, 1.37-1.73), and higher CRC risk with diabetes (OR, 1.65; 95% CI, 1.51-1.81) and alcohol use disorder (OR, 1.53; 95% CI, 1.35-1.73).

• Among 3714 CRC cases, 71.1% occurred in individuals aged 50-75 years not up to date with screening.

• A total of 12.5% of CRC cases occurred in people outside age 50-75 or with high-risk personal or family history, suggesting that conventional screening-adherence metrics may miss a clinically relevant minority.

IN PRACTICE:

“The conventional measure of CRC screening, focused on average-risk individuals aged 50 to 75, does not reflect screening status in an important minority of CRC patients," the authors wrote.

SOURCE:

The study was led by researchers at NYU Grossman School of Medicine and Veterans Affairs New York Harbor Health Care System, and published online July 9, 2026 in Medicine.

LIMITATIONS:

The study population consisted predominantly of male veterans (97.1%), who tend to be older and have more comorbidities compared with the US population, which may limit the generalizability of findings to other populations. Researchers defined screening status cross-sectionally relative to a single point in time rather than assessing longitudinal screening adherence, which may not fully capture the consistency of screening over time that is likely important for defining CRC risk. Veterans may receive screening at non-VA medical facilities, potentially leading to incomplete documentation of screening status and important covariates such as race, ethnicity, and comorbidities. The possibility of residual confounding cannot be excluded despite adjustment for multiple risk factors in the analysis.

DISCLOSURES:

This study received support from NIH grant K08 CA230162 and the AGA Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer, both awarded to Peter S. Liang. Liang disclosed receiving research support from Freenome and serving on the advisory boards for Guardant Health and Natera. The remaining authors reported no funding or conflicts of interest to disclose.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

More than 1 in 8 colorectal cancer (CRC) cases among veterans occur outside the standard screening age of 50-75 years or those with high-risk personal or family history. High-risk patients face > 6 times the risk for CRC compared with average-risk patients aged 50-75 years who are up to date with screening, while Black patients have > 50% higher risk compared with White patients.

METHODOLOGY:

• Researchers conducted a case-control analysis using Veterans Health Administration (VHA) Corporate Data Warehouse data from 2012-2018 at 2 sites: Veterans Affairs (VA) New York Harbor Health Care System and VA Puget Sound Health Care System.

• Participants included 3714 cases among veterans with CRC matched to 14,856 controls (4:1), with matching on age (± 3 years), sex, and facility site; each control was used once.

• Screening categories included 5 groups by age (50-75 years vs < 50 years or > 75 years), screening up-to-date status, and high-risk status (inflammatory bowel disease, hereditary cancer syndromes, or family history).

• CRC screening was considered up to date if US Preventive Services Task Force-recommended tests were completed on time (colonoscopy ≤ 10 years; guaiac-based fecal occult blood test or fecal immunochemical test ≤ 1 year).

TAKEAWAY:

• Compared with category 1 (age 50-75 years and up-to-date with screening), CRC was associated with category 4 (age < 50 years or > 75 years and not up to date) (odds ratio [OR], 1.40; 95% CI, 1.11-1.78), and category 5 (high risk) (OR, 6.23; 95% CI, 5.06-7.66).

• Race and comorbidity associations included higher CRC risk for Black vs White patients (OR, 1.54; 95% CI, 1.37-1.73), and higher CRC risk with diabetes (OR, 1.65; 95% CI, 1.51-1.81) and alcohol use disorder (OR, 1.53; 95% CI, 1.35-1.73).

• Among 3714 CRC cases, 71.1% occurred in individuals aged 50-75 years not up to date with screening.

• A total of 12.5% of CRC cases occurred in people outside age 50-75 or with high-risk personal or family history, suggesting that conventional screening-adherence metrics may miss a clinically relevant minority.

IN PRACTICE:

“The conventional measure of CRC screening, focused on average-risk individuals aged 50 to 75, does not reflect screening status in an important minority of CRC patients," the authors wrote.

SOURCE:

The study was led by researchers at NYU Grossman School of Medicine and Veterans Affairs New York Harbor Health Care System, and published online July 9, 2026 in Medicine.

LIMITATIONS:

The study population consisted predominantly of male veterans (97.1%), who tend to be older and have more comorbidities compared with the US population, which may limit the generalizability of findings to other populations. Researchers defined screening status cross-sectionally relative to a single point in time rather than assessing longitudinal screening adherence, which may not fully capture the consistency of screening over time that is likely important for defining CRC risk. Veterans may receive screening at non-VA medical facilities, potentially leading to incomplete documentation of screening status and important covariates such as race, ethnicity, and comorbidities. The possibility of residual confounding cannot be excluded despite adjustment for multiple risk factors in the analysis.

DISCLOSURES:

This study received support from NIH grant K08 CA230162 and the AGA Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer, both awarded to Peter S. Liang. Liang disclosed receiving research support from Freenome and serving on the advisory boards for Guardant Health and Natera. The remaining authors reported no funding or conflicts of interest to disclose.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

More than 1 in 8 colorectal cancer (CRC) cases among veterans occur outside the standard screening age of 50-75 years or those with high-risk personal or family history. High-risk patients face > 6 times the risk for CRC compared with average-risk patients aged 50-75 years who are up to date with screening, while Black patients have > 50% higher risk compared with White patients.

METHODOLOGY:

• Researchers conducted a case-control analysis using Veterans Health Administration (VHA) Corporate Data Warehouse data from 2012-2018 at 2 sites: Veterans Affairs (VA) New York Harbor Health Care System and VA Puget Sound Health Care System.

• Participants included 3714 cases among veterans with CRC matched to 14,856 controls (4:1), with matching on age (± 3 years), sex, and facility site; each control was used once.

• Screening categories included 5 groups by age (50-75 years vs < 50 years or > 75 years), screening up-to-date status, and high-risk status (inflammatory bowel disease, hereditary cancer syndromes, or family history).

• CRC screening was considered up to date if US Preventive Services Task Force-recommended tests were completed on time (colonoscopy ≤ 10 years; guaiac-based fecal occult blood test or fecal immunochemical test ≤ 1 year).

TAKEAWAY:

• Compared with category 1 (age 50-75 years and up-to-date with screening), CRC was associated with category 4 (age < 50 years or > 75 years and not up to date) (odds ratio [OR], 1.40; 95% CI, 1.11-1.78), and category 5 (high risk) (OR, 6.23; 95% CI, 5.06-7.66).

• Race and comorbidity associations included higher CRC risk for Black vs White patients (OR, 1.54; 95% CI, 1.37-1.73), and higher CRC risk with diabetes (OR, 1.65; 95% CI, 1.51-1.81) and alcohol use disorder (OR, 1.53; 95% CI, 1.35-1.73).

• Among 3714 CRC cases, 71.1% occurred in individuals aged 50-75 years not up to date with screening.

• A total of 12.5% of CRC cases occurred in people outside age 50-75 or with high-risk personal or family history, suggesting that conventional screening-adherence metrics may miss a clinically relevant minority.

IN PRACTICE:

“The conventional measure of CRC screening, focused on average-risk individuals aged 50 to 75, does not reflect screening status in an important minority of CRC patients," the authors wrote.

SOURCE:

The study was led by researchers at NYU Grossman School of Medicine and Veterans Affairs New York Harbor Health Care System, and published online July 9, 2026 in Medicine.

LIMITATIONS:

The study population consisted predominantly of male veterans (97.1%), who tend to be older and have more comorbidities compared with the US population, which may limit the generalizability of findings to other populations. Researchers defined screening status cross-sectionally relative to a single point in time rather than assessing longitudinal screening adherence, which may not fully capture the consistency of screening over time that is likely important for defining CRC risk. Veterans may receive screening at non-VA medical facilities, potentially leading to incomplete documentation of screening status and important covariates such as race, ethnicity, and comorbidities. The possibility of residual confounding cannot be excluded despite adjustment for multiple risk factors in the analysis.

DISCLOSURES:

This study received support from NIH grant K08 CA230162 and the AGA Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer, both awarded to Peter S. Liang. Liang disclosed receiving research support from Freenome and serving on the advisory boards for Guardant Health and Natera. The remaining authors reported no funding or conflicts of interest to disclose.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Interviews with 23 male veterans (aged 35-49 years) at average-risk for colorectal cancer (CRC) and 8 primary care practitioners (PCPs) found broad acceptability of the Colon Age concept, with 96% of patients agreeing to calculation. PCPs describe its potential use to support screening discussions (fecal immunochemical test [FIT] vs colonoscopy) but emphasize workflow barriers, requesting electronic medical record integration and “time neutral” implementation.

METHODOLOGY:

• Researchers conducted semistructured qualitative interviews with 31 participants (23 male veteran patients aged 35-49 years and 8 PCPs) at the Richard L. Roudebush Veterans Affairs Medical Center between June and September 2022.

• Patients were eligible if they were at average risk for CRC, had no prior screening (colonoscopy or fecal immunochemical test [FIT]), no inflammatory bowel disease, and no significant family history of CRC.

• Interviews explored participants' experiences with CRC screening, understanding of the Colon Age tool, and perceived clinical use.

• Audio-recorded interviews were transcribed, deidentified, and analyzed using the constant comparison method with open and focused coding phases until saturation was reached. 

TAKEAWAY:

• Among 23 male veteran patients (mean age 47 years), 96% agreed to have their Colon Age calculated; 68% had a Colon Age below their biological age, 14% higher than their biological age, and 18% equal to their biological age.

• Patients accepted the Colon Age concept, finding it easy to understand and helpful for being informed about their health, though most were unaware of screening options beyond colonoscopy prior to the interview.

• The 8 PCPs (mean age 53 years, 50% female, mean 29 years in practice) interviewed found the tool acceptable and useful for screening conversations, improving uptake, and facilitating shared decision-making, particularly in gray zone cases where screening decisions are unclear.

• PCPs emphasized the need for the tool to be integrated into the electronic medical record system and expressed concerns about time commitment, consistency with practice guidelines, and the validation process, stating they would only use the tool if it were time neutral and evidence-based. 

IN PRACTICE: “Although the age at which to begin colorectal cancer screening in the US was lowered to 45 years in 2018, uptake of screening in persons aged 45 to 49 has been slow,” wrote the authors of the study.

SOURCE:The study was led by researchers at the VA Center for Health Information and Communication. It was published online on July 15 in BMC Primary Care.

LIMITATIONS: The study was conducted at a single VA medical center in the Midwest and all patient participants were male, which may limit generalizability to nonveteran patients, female patients, and non-VA clinicians. The Colon Age tool has limitations, as it was based on a risk prediction model with modest discrimination, and the linkage to screening recommendations was based on arbitrary Surveillance, Epidemiology and End Results thresholds chosen by the tool developers. Additionally, the qualitative nature of the study with a small sample size may not capture the full range of perspectives across diverse health care settings and patient populations.

DISCLOSURES: The primary author received support from Health Services Research and Development, Veterans Administration. Funding for this project was provided by Richard L. Roudebush VA Medical Center Indianapolis, Indiana Center for Health Information, and Communication COIN funds. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Among Veterans Health Administration (VHA) patients experiencing homelessness, gaining housing is linked to higher 24-month colorectal (CRC) and breast cancer screening completion. In cohorts of 117,619 veterans eligible for colorectal screening and 6517 veterans eligible for breast cancer screening veterans, screening occurs in 36.1% and 47.9% after housing gain vs 18.8% and 23.7% if homelessness persists.

METHODOLOGY

• A retrospective cohort study examined all veterans experiencing homelessness who received care at the VHA from 2011 to 2021 and were eligible for but not up to date on CRC and breast cancer screening.

• 117,619 veterans experiencing homelessness were eligible for but not up to date on CRC screening (aged 50-75 years without prior cancer diagnosis, inflammatory bowel disease, or colectomy) and 6517 veterans experiencing homelessness were eligible for but not up to date on breast cancer screening (women aged 50-75 years without prior cancer diagnosis, lumpectomy, or mastectomy) were included at their index clinic visit.

• Exposure was defined as gaining housing within 24 months following index clinic visit, identified through the Homeless Screening Clinical Reminder, US Department of Veterans Affairs (VA) Homeless Operations, Management, and Evaluation System assessments, or US Department of Housing and Urban Development—VA Supportive Housing program move-in dates.

• Primary outcome were undergoing screening for CRC (colonoscopy, flexible sigmoidoscopy, computed tomography colonography, barium enema, or stool-based study) or breast cancer (mammogram) that was at a VHA facility or paid by VA within 24 months following index clinic visit.

TAKEAWAY

• Among veterans who gained housing, 36.1% underwent CRC screening and 47.9% underwent breast cancer screening during the 24-month observation period, compared with 18.8% and 23.7% of veterans, respectively, among those who remained homeless.

• Veterans who gained housing had 2.3 times the adjusted hazard ratio (aHR) of undergoing CRC screening compared with those who remained homeless (AHR, 2.3; 95% CI, 2.2-2.3; P < .001).

• Veterans who gained housing had 2.4 times the adjusted hazard of undergoing breast cancer screening compared with those who remained homeless (AHR, 2.4; 95% CI, 2.2-2.7; P < .001).

• Median (interquartile range [IQR]) time from index visit to cancer screening was 8 months (4-15) for CRC screening and 8 months (3-14) for breast cancer screening; median (IQR) time from gaining housing to screening was 4 months (1-9) and 3 months (1-8), respectively.

IN PRACTICE: Veterans experiencing homelessness who gain housing have higher rates of cancer screening. “This finding supports promotion of housing to improve health outcomes for homeless individuals," wrote the authors of the study.

SOURCE: The study was led by researchers at the University of California, San Francisco. It was published online in Annals of Family Medicine.

LIMITATIONS: Residual unmeasured confounding was likely due to the observational design of this study, because veterans able to navigate services to obtain housing may also be more likely to complete preventive care. Housing transitions may be misclassified because the Homeless Screening Clinical Reminder was not designed to track changes and may not be administered to veterans already identified as experiencing homelessness. The study did not capture data for screening completed outside VHA or that was not paid for by it. The study cohort only includes veterans with VHA contact, which may limit generalizability.

DISCLOSURES: Benioff Homelessness and Housing Initiative provided grant support for the work; Project Grant K24AG046372 was also awarded to Kushel for the study. Decker is a National Clinician Scholar with salary support from the US Department of Veterans Affairs and reported receiving personal fees from Moon Surgical. Kanzaria and Kushel are faculty members of the Benioff Homelessness and Housing Initiative; Kanzaria also reported advisory work for Amae Health. Kushel is listed as serving on boards including Housing California, National Homelessness Law Center, and Steinberg Institute; other authors reported no conflicts.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Among Veterans Health Administration (VHA) patients experiencing homelessness, gaining housing is linked to higher 24-month colorectal (CRC) and breast cancer screening completion. In cohorts of 117,619 veterans eligible for colorectal screening and 6517 veterans eligible for breast cancer screening veterans, screening occurs in 36.1% and 47.9% after housing gain vs 18.8% and 23.7% if homelessness persists.

METHODOLOGY

• A retrospective cohort study examined all veterans experiencing homelessness who received care at the VHA from 2011 to 2021 and were eligible for but not up to date on CRC and breast cancer screening.

• 117,619 veterans experiencing homelessness were eligible for but not up to date on CRC screening (aged 50-75 years without prior cancer diagnosis, inflammatory bowel disease, or colectomy) and 6517 veterans experiencing homelessness were eligible for but not up to date on breast cancer screening (women aged 50-75 years without prior cancer diagnosis, lumpectomy, or mastectomy) were included at their index clinic visit.

• Exposure was defined as gaining housing within 24 months following index clinic visit, identified through the Homeless Screening Clinical Reminder, US Department of Veterans Affairs (VA) Homeless Operations, Management, and Evaluation System assessments, or US Department of Housing and Urban Development—VA Supportive Housing program move-in dates.

• Primary outcome were undergoing screening for CRC (colonoscopy, flexible sigmoidoscopy, computed tomography colonography, barium enema, or stool-based study) or breast cancer (mammogram) that was at a VHA facility or paid by VA within 24 months following index clinic visit.

TAKEAWAY

• Among veterans who gained housing, 36.1% underwent CRC screening and 47.9% underwent breast cancer screening during the 24-month observation period, compared with 18.8% and 23.7% of veterans, respectively, among those who remained homeless.

• Veterans who gained housing had 2.3 times the adjusted hazard ratio (aHR) of undergoing CRC screening compared with those who remained homeless (AHR, 2.3; 95% CI, 2.2-2.3; P < .001).

• Veterans who gained housing had 2.4 times the adjusted hazard of undergoing breast cancer screening compared with those who remained homeless (AHR, 2.4; 95% CI, 2.2-2.7; P < .001).

• Median (interquartile range [IQR]) time from index visit to cancer screening was 8 months (4-15) for CRC screening and 8 months (3-14) for breast cancer screening; median (IQR) time from gaining housing to screening was 4 months (1-9) and 3 months (1-8), respectively.

IN PRACTICE: Veterans experiencing homelessness who gain housing have higher rates of cancer screening. “This finding supports promotion of housing to improve health outcomes for homeless individuals," wrote the authors of the study.

SOURCE: The study was led by researchers at the University of California, San Francisco. It was published online in Annals of Family Medicine.

LIMITATIONS: Residual unmeasured confounding was likely due to the observational design of this study, because veterans able to navigate services to obtain housing may also be more likely to complete preventive care. Housing transitions may be misclassified because the Homeless Screening Clinical Reminder was not designed to track changes and may not be administered to veterans already identified as experiencing homelessness. The study did not capture data for screening completed outside VHA or that was not paid for by it. The study cohort only includes veterans with VHA contact, which may limit generalizability.

DISCLOSURES: Benioff Homelessness and Housing Initiative provided grant support for the work; Project Grant K24AG046372 was also awarded to Kushel for the study. Decker is a National Clinician Scholar with salary support from the US Department of Veterans Affairs and reported receiving personal fees from Moon Surgical. Kanzaria and Kushel are faculty members of the Benioff Homelessness and Housing Initiative; Kanzaria also reported advisory work for Amae Health. Kushel is listed as serving on boards including Housing California, National Homelessness Law Center, and Steinberg Institute; other authors reported no conflicts.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: Among Veterans Health Administration (VHA) patients experiencing homelessness, gaining housing is linked to higher 24-month colorectal (CRC) and breast cancer screening completion. In cohorts of 117,619 veterans eligible for colorectal screening and 6517 veterans eligible for breast cancer screening veterans, screening occurs in 36.1% and 47.9% after housing gain vs 18.8% and 23.7% if homelessness persists.

METHODOLOGY

• A retrospective cohort study examined all veterans experiencing homelessness who received care at the VHA from 2011 to 2021 and were eligible for but not up to date on CRC and breast cancer screening.

• 117,619 veterans experiencing homelessness were eligible for but not up to date on CRC screening (aged 50-75 years without prior cancer diagnosis, inflammatory bowel disease, or colectomy) and 6517 veterans experiencing homelessness were eligible for but not up to date on breast cancer screening (women aged 50-75 years without prior cancer diagnosis, lumpectomy, or mastectomy) were included at their index clinic visit.

• Exposure was defined as gaining housing within 24 months following index clinic visit, identified through the Homeless Screening Clinical Reminder, US Department of Veterans Affairs (VA) Homeless Operations, Management, and Evaluation System assessments, or US Department of Housing and Urban Development—VA Supportive Housing program move-in dates.

• Primary outcome were undergoing screening for CRC (colonoscopy, flexible sigmoidoscopy, computed tomography colonography, barium enema, or stool-based study) or breast cancer (mammogram) that was at a VHA facility or paid by VA within 24 months following index clinic visit.

TAKEAWAY

• Among veterans who gained housing, 36.1% underwent CRC screening and 47.9% underwent breast cancer screening during the 24-month observation period, compared with 18.8% and 23.7% of veterans, respectively, among those who remained homeless.

• Veterans who gained housing had 2.3 times the adjusted hazard ratio (aHR) of undergoing CRC screening compared with those who remained homeless (AHR, 2.3; 95% CI, 2.2-2.3; P < .001).

• Veterans who gained housing had 2.4 times the adjusted hazard of undergoing breast cancer screening compared with those who remained homeless (AHR, 2.4; 95% CI, 2.2-2.7; P < .001).

• Median (interquartile range [IQR]) time from index visit to cancer screening was 8 months (4-15) for CRC screening and 8 months (3-14) for breast cancer screening; median (IQR) time from gaining housing to screening was 4 months (1-9) and 3 months (1-8), respectively.

IN PRACTICE: Veterans experiencing homelessness who gain housing have higher rates of cancer screening. “This finding supports promotion of housing to improve health outcomes for homeless individuals," wrote the authors of the study.

SOURCE: The study was led by researchers at the University of California, San Francisco. It was published online in Annals of Family Medicine.

LIMITATIONS: Residual unmeasured confounding was likely due to the observational design of this study, because veterans able to navigate services to obtain housing may also be more likely to complete preventive care. Housing transitions may be misclassified because the Homeless Screening Clinical Reminder was not designed to track changes and may not be administered to veterans already identified as experiencing homelessness. The study did not capture data for screening completed outside VHA or that was not paid for by it. The study cohort only includes veterans with VHA contact, which may limit generalizability.

DISCLOSURES: Benioff Homelessness and Housing Initiative provided grant support for the work; Project Grant K24AG046372 was also awarded to Kushel for the study. Decker is a National Clinician Scholar with salary support from the US Department of Veterans Affairs and reported receiving personal fees from Moon Surgical. Kanzaria and Kushel are faculty members of the Benioff Homelessness and Housing Initiative; Kanzaria also reported advisory work for Amae Health. Kushel is listed as serving on boards including Housing California, National Homelessness Law Center, and Steinberg Institute; other authors reported no conflicts.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Mailed fecal immunochemical test (FIT) kits with reminder phone calls promote colorectal cancer (CRC) screening among veterans without recent primary care visits. Among 782 veterans in a randomized controlled trial (RCT), mailed FITs resulted in a 26.1% screening completion rate within 6 months, compared with 5.8% for usual care and 7.7% for mailed invitations with reminders. Improving screening in this population may help CRC morbidity and mortality among veterans.

METHODOLOGY:

• Researchers conducted a 3-arm pragmatic RCT at the US Department of Verterans Affairs (VA) Corporal Michael J. Crescenz VA Medical Center (CMC-VAMC), enrolling veterans aged 50 to 75 years without a primary care visit within 18 months.
• Participants were randomized 1:1:1 to usual care (n = 260), mailed clinic-based screening invitations with reminder calls (n = 261), or mailed home FIT outreach plus prenotification letter and reminder phone calls (n = 261).
• Outcome measures included documented completion of CRC screening within 6 months after randomization in the electronic health record (EHR); a secondary outcome was FIT return within 6 months among those mailed FIT.
• Eligibility and exclusions were based on chart review and EHR criteria (eg, excluding symptoms, family history, inflammatory bowel disease, prior resection, or being current by having undergone a colonoscopy within 10 years, sigmoidoscopy or barium enema within 5 years, or fecal occult blood testing within 1 year).

TAKEAWAY

• CRC screening completion within 6 months is 26.1% with mailed FIT vs 5.8% with usual care (RD, 20.3%; 95% CI, 14.3%-26.3%; RR, 4.5; 95% CI, 2.7-7.7; P < .001).
• CRC screening completion within 6 months is 26.1% with mailed FIT vs 7.7% with mailed invitation plus reminders (RD, 18.4%; 95% CI, 12.2%-24.6%; RR, 3.4; 95% CI, 2.1-5.4; P < .001).
• Screening completion does not differ between mailed invitation plus reminders (7.7%) and usual care (5.8%), and the comparison is not statistically supported (RR, 1.3; P = .39).
• No statistically significant differences in screening completion are reported by age or race/ethnicity, and investigators also report no significant differences in FIT return by age or race/ethnicity in the secondary analysis.

IN PRACTICE

“This research represents the first pragmatic RCT of mailed FIT outreach screening among veterans who have not recently (18 months) used primary care services offered by the VA. In this work, there were large relative, and absolute differences in CRC screening participation rate between veterans offered home FIT screening and those who received usual care (RR = 4.52, RD = 20.2%) or a mailed invitation plus reminders (RR = 3.40, RD = 18.4%)," wrote the authors.

SOURCE

The study was led by Matthew A. Goldshore, MD, PhD, MPH, of the CMC-VAMC . It was published online in Am J Prev Med.

LIMITATIONS

The study was not able identify differences in screening completion or FIT return by patient demographic characteristics such as age and race. The sample was randomized from predominantly male veterans cared for at a single VA medical center, limiting generalizability and reducing external validity. Follow-up and subsequent evaluation of FIT-positive participants is needed for the success of a mailed FIT intervention; of the 3 FIT-positive participants who should have received follow-up evaluation, only 1 underwent colonoscopy, highlighting the challenge of FIT to colonoscopy among participants who do not use care regularly at the CMC-VAMC.

DISCLOSURES

This trial received funding from an VA Health Services Research and Development Service award, with E. Carter Paulson, MD, MSCE, and Chyke A. Doubeni, MD, MPH, serving as principal investigators. Chyke A. Doubeni received support from grant number RO1CA 213645, and Shivan J. Mehta received support from grant number K08CA 234326, both from the National Cancer Institute of the National Institutes of Health. The authors reported no financial disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Mailed fecal immunochemical test (FIT) kits with reminder phone calls promote colorectal cancer (CRC) screening among veterans without recent primary care visits. Among 782 veterans in a randomized controlled trial (RCT), mailed FITs resulted in a 26.1% screening completion rate within 6 months, compared with 5.8% for usual care and 7.7% for mailed invitations with reminders. Improving screening in this population may help CRC morbidity and mortality among veterans.

METHODOLOGY:

• Researchers conducted a 3-arm pragmatic RCT at the US Department of Verterans Affairs (VA) Corporal Michael J. Crescenz VA Medical Center (CMC-VAMC), enrolling veterans aged 50 to 75 years without a primary care visit within 18 months.
• Participants were randomized 1:1:1 to usual care (n = 260), mailed clinic-based screening invitations with reminder calls (n = 261), or mailed home FIT outreach plus prenotification letter and reminder phone calls (n = 261).
• Outcome measures included documented completion of CRC screening within 6 months after randomization in the electronic health record (EHR); a secondary outcome was FIT return within 6 months among those mailed FIT.
• Eligibility and exclusions were based on chart review and EHR criteria (eg, excluding symptoms, family history, inflammatory bowel disease, prior resection, or being current by having undergone a colonoscopy within 10 years, sigmoidoscopy or barium enema within 5 years, or fecal occult blood testing within 1 year).

TAKEAWAY

• CRC screening completion within 6 months is 26.1% with mailed FIT vs 5.8% with usual care (RD, 20.3%; 95% CI, 14.3%-26.3%; RR, 4.5; 95% CI, 2.7-7.7; P < .001).
• CRC screening completion within 6 months is 26.1% with mailed FIT vs 7.7% with mailed invitation plus reminders (RD, 18.4%; 95% CI, 12.2%-24.6%; RR, 3.4; 95% CI, 2.1-5.4; P < .001).
• Screening completion does not differ between mailed invitation plus reminders (7.7%) and usual care (5.8%), and the comparison is not statistically supported (RR, 1.3; P = .39).
• No statistically significant differences in screening completion are reported by age or race/ethnicity, and investigators also report no significant differences in FIT return by age or race/ethnicity in the secondary analysis.

IN PRACTICE

“This research represents the first pragmatic RCT of mailed FIT outreach screening among veterans who have not recently (18 months) used primary care services offered by the VA. In this work, there were large relative, and absolute differences in CRC screening participation rate between veterans offered home FIT screening and those who received usual care (RR = 4.52, RD = 20.2%) or a mailed invitation plus reminders (RR = 3.40, RD = 18.4%)," wrote the authors.

SOURCE

The study was led by Matthew A. Goldshore, MD, PhD, MPH, of the CMC-VAMC . It was published online in Am J Prev Med.

LIMITATIONS

The study was not able identify differences in screening completion or FIT return by patient demographic characteristics such as age and race. The sample was randomized from predominantly male veterans cared for at a single VA medical center, limiting generalizability and reducing external validity. Follow-up and subsequent evaluation of FIT-positive participants is needed for the success of a mailed FIT intervention; of the 3 FIT-positive participants who should have received follow-up evaluation, only 1 underwent colonoscopy, highlighting the challenge of FIT to colonoscopy among participants who do not use care regularly at the CMC-VAMC.

DISCLOSURES

This trial received funding from an VA Health Services Research and Development Service award, with E. Carter Paulson, MD, MSCE, and Chyke A. Doubeni, MD, MPH, serving as principal investigators. Chyke A. Doubeni received support from grant number RO1CA 213645, and Shivan J. Mehta received support from grant number K08CA 234326, both from the National Cancer Institute of the National Institutes of Health. The authors reported no financial disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Mailed fecal immunochemical test (FIT) kits with reminder phone calls promote colorectal cancer (CRC) screening among veterans without recent primary care visits. Among 782 veterans in a randomized controlled trial (RCT), mailed FITs resulted in a 26.1% screening completion rate within 6 months, compared with 5.8% for usual care and 7.7% for mailed invitations with reminders. Improving screening in this population may help CRC morbidity and mortality among veterans.

METHODOLOGY:

• Researchers conducted a 3-arm pragmatic RCT at the US Department of Verterans Affairs (VA) Corporal Michael J. Crescenz VA Medical Center (CMC-VAMC), enrolling veterans aged 50 to 75 years without a primary care visit within 18 months.
• Participants were randomized 1:1:1 to usual care (n = 260), mailed clinic-based screening invitations with reminder calls (n = 261), or mailed home FIT outreach plus prenotification letter and reminder phone calls (n = 261).
• Outcome measures included documented completion of CRC screening within 6 months after randomization in the electronic health record (EHR); a secondary outcome was FIT return within 6 months among those mailed FIT.
• Eligibility and exclusions were based on chart review and EHR criteria (eg, excluding symptoms, family history, inflammatory bowel disease, prior resection, or being current by having undergone a colonoscopy within 10 years, sigmoidoscopy or barium enema within 5 years, or fecal occult blood testing within 1 year).

TAKEAWAY

• CRC screening completion within 6 months is 26.1% with mailed FIT vs 5.8% with usual care (RD, 20.3%; 95% CI, 14.3%-26.3%; RR, 4.5; 95% CI, 2.7-7.7; P < .001).
• CRC screening completion within 6 months is 26.1% with mailed FIT vs 7.7% with mailed invitation plus reminders (RD, 18.4%; 95% CI, 12.2%-24.6%; RR, 3.4; 95% CI, 2.1-5.4; P < .001).
• Screening completion does not differ between mailed invitation plus reminders (7.7%) and usual care (5.8%), and the comparison is not statistically supported (RR, 1.3; P = .39).
• No statistically significant differences in screening completion are reported by age or race/ethnicity, and investigators also report no significant differences in FIT return by age or race/ethnicity in the secondary analysis.

IN PRACTICE

“This research represents the first pragmatic RCT of mailed FIT outreach screening among veterans who have not recently (18 months) used primary care services offered by the VA. In this work, there were large relative, and absolute differences in CRC screening participation rate between veterans offered home FIT screening and those who received usual care (RR = 4.52, RD = 20.2%) or a mailed invitation plus reminders (RR = 3.40, RD = 18.4%)," wrote the authors.

SOURCE

The study was led by Matthew A. Goldshore, MD, PhD, MPH, of the CMC-VAMC . It was published online in Am J Prev Med.

LIMITATIONS

The study was not able identify differences in screening completion or FIT return by patient demographic characteristics such as age and race. The sample was randomized from predominantly male veterans cared for at a single VA medical center, limiting generalizability and reducing external validity. Follow-up and subsequent evaluation of FIT-positive participants is needed for the success of a mailed FIT intervention; of the 3 FIT-positive participants who should have received follow-up evaluation, only 1 underwent colonoscopy, highlighting the challenge of FIT to colonoscopy among participants who do not use care regularly at the CMC-VAMC.

DISCLOSURES

This trial received funding from an VA Health Services Research and Development Service award, with E. Carter Paulson, MD, MSCE, and Chyke A. Doubeni, MD, MPH, serving as principal investigators. Chyke A. Doubeni received support from grant number RO1CA 213645, and Shivan J. Mehta received support from grant number K08CA 234326, both from the National Cancer Institute of the National Institutes of Health. The authors reported no financial disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: 

A recalibrated environmental risk score for colorectal cancer (CRC) shows improved predictive performance in a study of 227,504 male veterans. The veteran-tailored score could help personalize screening better than previous models.

METHODOLOGY: 

• Demographic, lifestyle, and CRC data from 2011 to 2022 were abstracted from survey responses and health records of 227,504 male Million Veteran Program (MVP) participants, with complete data needed to construct the environmental risk score (e-Score).
• Researchers randomly split the male sample into 2 halves to produce training and validation samples (each n = 113,752; CRC cases n = 590) using simple random sampling with strata based on the CRC variable.
• Weighting for each environmental factor's effect size was recalculated using US Department of Veterans Affairs training data to create a recalibrated e-Score, which was compared with the original weighted e-Score in the validation sample.
• Analysis included nested multiple logistic regression models testing associations between quintiles for recalibrated and original e-Scores, with likelihood ratio tests used to compare model performance.
• Factors used to construct the e-Score included BMI, height, diabetes diagnosis, aspirin use, nonsteroidal anti-inflammatory drug use, educational attainment, physical activity level, smoking status, alcohol use, and dietary intake of fiber, calcium, folate, processed meats, red meat, fruits, vegetables, and total energy.

TAKEAWAY:

• The recalibrated e-Score showed a significant association with CRC, with higher quintiles indicating increased risk.
• In the validation sample, the recalibrated e-Score model significantly improved the base model performance (P < .001), while the original GECCO e-Score model did not show significant improvement (P = .07).
• The recalibrated e-Score model quintile 5 was associated with significantly higher odds for CRC compared with quintile 1 (odds ratio [OR], 1.79; 95% CI, 1.38-2.33; P for trend < .001).
• Black participants had higher odds for CRC compared with the White reference group across all models (base model OR, 1.46; 95% CI, 1.13-1.92; GECCO e-Score model OR, 1.44; 95% CI, 1.09-1.88; and recalibrated e-Score model OR, 1.38; 95% CI, 1.05-1.82).

IN PRACTICE:

"Despite the robust methods used in the work by the GECCO study upon which our study was based, an e-Score using their study’s weighting was not significantly associated with colorectal cancer among the male veteran sample. However, data from nearly a quarter million (n = 227,504) male US veteran participants of the MVP were used to recalibrate the e-Score to be veteran specific, and the recalibrated e-Score validation showed that it was significantly associated with colorectal cancer," wrote the authors of the study.

SOURCE:

The study was led by April R. Williams, US Department of Veterans Affairs Million Veteran Program Coordinating Center in Boston. It was published online in Cancer Epidemiology, Biomarkers & Prevention.

LIMITATIONS:

The study's limitations include potential recall and self-selection bias due to the use of self-reported data from the MVP. The generalizability of the findings may be limited to the veteran population, and the sample of Black veterans may have been insufficient for conclusive analysis. Additionally, the study did not include female participants due to insufficient data for a veteran-specific e-Score.

DISCLOSURES:

B.A. Sullivan disclosed receiving grants from the American Gastroenterological Association. D. Lieberman reported support from Geneoscopy, UDX, and ColoWrap. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: 

A recalibrated environmental risk score for colorectal cancer (CRC) shows improved predictive performance in a study of 227,504 male veterans. The veteran-tailored score could help personalize screening better than previous models.

METHODOLOGY: 

• Demographic, lifestyle, and CRC data from 2011 to 2022 were abstracted from survey responses and health records of 227,504 male Million Veteran Program (MVP) participants, with complete data needed to construct the environmental risk score (e-Score).
• Researchers randomly split the male sample into 2 halves to produce training and validation samples (each n = 113,752; CRC cases n = 590) using simple random sampling with strata based on the CRC variable.
• Weighting for each environmental factor's effect size was recalculated using US Department of Veterans Affairs training data to create a recalibrated e-Score, which was compared with the original weighted e-Score in the validation sample.
• Analysis included nested multiple logistic regression models testing associations between quintiles for recalibrated and original e-Scores, with likelihood ratio tests used to compare model performance.
• Factors used to construct the e-Score included BMI, height, diabetes diagnosis, aspirin use, nonsteroidal anti-inflammatory drug use, educational attainment, physical activity level, smoking status, alcohol use, and dietary intake of fiber, calcium, folate, processed meats, red meat, fruits, vegetables, and total energy.

TAKEAWAY:

• The recalibrated e-Score showed a significant association with CRC, with higher quintiles indicating increased risk.
• In the validation sample, the recalibrated e-Score model significantly improved the base model performance (P < .001), while the original GECCO e-Score model did not show significant improvement (P = .07).
• The recalibrated e-Score model quintile 5 was associated with significantly higher odds for CRC compared with quintile 1 (odds ratio [OR], 1.79; 95% CI, 1.38-2.33; P for trend < .001).
• Black participants had higher odds for CRC compared with the White reference group across all models (base model OR, 1.46; 95% CI, 1.13-1.92; GECCO e-Score model OR, 1.44; 95% CI, 1.09-1.88; and recalibrated e-Score model OR, 1.38; 95% CI, 1.05-1.82).

IN PRACTICE:

"Despite the robust methods used in the work by the GECCO study upon which our study was based, an e-Score using their study’s weighting was not significantly associated with colorectal cancer among the male veteran sample. However, data from nearly a quarter million (n = 227,504) male US veteran participants of the MVP were used to recalibrate the e-Score to be veteran specific, and the recalibrated e-Score validation showed that it was significantly associated with colorectal cancer," wrote the authors of the study.

SOURCE:

The study was led by April R. Williams, US Department of Veterans Affairs Million Veteran Program Coordinating Center in Boston. It was published online in Cancer Epidemiology, Biomarkers & Prevention.

LIMITATIONS:

The study's limitations include potential recall and self-selection bias due to the use of self-reported data from the MVP. The generalizability of the findings may be limited to the veteran population, and the sample of Black veterans may have been insufficient for conclusive analysis. Additionally, the study did not include female participants due to insufficient data for a veteran-specific e-Score.

DISCLOSURES:

B.A. Sullivan disclosed receiving grants from the American Gastroenterological Association. D. Lieberman reported support from Geneoscopy, UDX, and ColoWrap. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE: 

A recalibrated environmental risk score for colorectal cancer (CRC) shows improved predictive performance in a study of 227,504 male veterans. The veteran-tailored score could help personalize screening better than previous models.

METHODOLOGY: 

• Demographic, lifestyle, and CRC data from 2011 to 2022 were abstracted from survey responses and health records of 227,504 male Million Veteran Program (MVP) participants, with complete data needed to construct the environmental risk score (e-Score).
• Researchers randomly split the male sample into 2 halves to produce training and validation samples (each n = 113,752; CRC cases n = 590) using simple random sampling with strata based on the CRC variable.
• Weighting for each environmental factor's effect size was recalculated using US Department of Veterans Affairs training data to create a recalibrated e-Score, which was compared with the original weighted e-Score in the validation sample.
• Analysis included nested multiple logistic regression models testing associations between quintiles for recalibrated and original e-Scores, with likelihood ratio tests used to compare model performance.
• Factors used to construct the e-Score included BMI, height, diabetes diagnosis, aspirin use, nonsteroidal anti-inflammatory drug use, educational attainment, physical activity level, smoking status, alcohol use, and dietary intake of fiber, calcium, folate, processed meats, red meat, fruits, vegetables, and total energy.

TAKEAWAY:

• The recalibrated e-Score showed a significant association with CRC, with higher quintiles indicating increased risk.
• In the validation sample, the recalibrated e-Score model significantly improved the base model performance (P < .001), while the original GECCO e-Score model did not show significant improvement (P = .07).
• The recalibrated e-Score model quintile 5 was associated with significantly higher odds for CRC compared with quintile 1 (odds ratio [OR], 1.79; 95% CI, 1.38-2.33; P for trend < .001).
• Black participants had higher odds for CRC compared with the White reference group across all models (base model OR, 1.46; 95% CI, 1.13-1.92; GECCO e-Score model OR, 1.44; 95% CI, 1.09-1.88; and recalibrated e-Score model OR, 1.38; 95% CI, 1.05-1.82).

IN PRACTICE:

"Despite the robust methods used in the work by the GECCO study upon which our study was based, an e-Score using their study’s weighting was not significantly associated with colorectal cancer among the male veteran sample. However, data from nearly a quarter million (n = 227,504) male US veteran participants of the MVP were used to recalibrate the e-Score to be veteran specific, and the recalibrated e-Score validation showed that it was significantly associated with colorectal cancer," wrote the authors of the study.

SOURCE:

The study was led by April R. Williams, US Department of Veterans Affairs Million Veteran Program Coordinating Center in Boston. It was published online in Cancer Epidemiology, Biomarkers & Prevention.

LIMITATIONS:

The study's limitations include potential recall and self-selection bias due to the use of self-reported data from the MVP. The generalizability of the findings may be limited to the veteran population, and the sample of Black veterans may have been insufficient for conclusive analysis. Additionally, the study did not include female participants due to insufficient data for a veteran-specific e-Score.

DISCLOSURES:

B.A. Sullivan disclosed receiving grants from the American Gastroenterological Association. D. Lieberman reported support from Geneoscopy, UDX, and ColoWrap. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.