John et al. Page 1792

Cancer family history is an important component of risk assessment. John and colleagues compared family history reports by women with breast cancer from a multiethnic population to self-reports by their first-degree relatives and to cancer registry records. Accuracy was highest for breast cancer and similar for non-Hispanic whites, African Americans, and Asian Americans, with little variation by other demographic characteristics, but was lower for Hispanic whites and women with limited English language proficiency. For breast cancer, family history reports can be used when they cannot be validated with other methods, but for other cancers, validation with medical records is important.

Adcock et al. Page 1816

Human papillomavirus (HPV) testing for cervical cancer shows greater sensitivity for detecting precancer. However, triage tests are needed to identify which HPV-positive lesions will progress. In a large population-based sample of liquid-based cytology by Adcock and colleagues, HPV genotyping and viral load were measured. Viral load (high, medium, low) added important risk information beyond HPV genotype hierarchy. High viral loads of HPV-18, -35, -52, and -58 carried more risk than low viral loads of HPV-16, -31, and -33. The ability to identify women at higher risk of developing cancer based on both HPV genotype and viral load could be important for individualizing triage plans.

Hamada et al. Page 1868

Telomere shortening occurs at an early stage of pancreatic carcinogenesis. Highly shortened telomeres increase incidence of pancreatic cancer through sustained chromosomal instability. Leukocyte telomere length may surrogate systemic telomere length and exposure to cancer risk factors. The prognostic association of prediagnostic leukocyte telomere length has not been fully examined in patients with pancreatic cancer. In a pooled analysis of four prospective cohort studies, Hamada and colleagues found that shorter prediagnostic leukocyte telomere length was associated with reduced survival of pancreatic cancer patients. Prediagnostic leukocyte telomere length can be a prognostic biomarker in pancreatic cancer. Dysregulated telomere maintenance may impact tumor behavior after diagnosis of pancreatic cancer.

Lieberman et al. Page 1902

Financial incentives could potentially improve health behaviors. However, evidence on the longitudinal effectiveness of financial incentives has been primarily limited to habitual behaviors, leaving an important knowledge gap with respect to challenges like cancer screening (a periodic behavior). Lieberman and colleagues tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually. The 3-year randomized controlled trial offered financial incentives as part of an outreach to complete annual colorectal cancer (CRC) screening using FIT. Results suggest modest incentives are unlikely to influence patients' CRC screening behavior. The findings highlight the importance of considering the social, cultural, and psychological barriers inherent to a behavior and of designing interventions to specifically address those barriers.