130 Background: Breast cancer (BC) screening is an integral part of cancer prevention. COVID-19 posed multiple obstacles on ensuring continuity of cancer care. The short and long-term outcomes of the pandemic on BC screening is unknown. The purpose of this study is to examine the challenges the pandemic has on mammogram completion using a granular measure of social economic deprivation: Area deprivation index (ADI). Methods: A Retrospective cohort study was conducted at an academic hospital system at the epicenter of COVID-19 pandemic comparing BC screening rates during the year of 2019 (pre-COVID19) and 2020 (COVID-19). For the year 2020, only charts between January-February and July-December were reviewed. March-June period was avoided as the USA declared a national emergency and the American Cancer Society recommended to temporarily pause cancer screening. The outcome variable was mammogram completion. The predictor variables were: COVID-19 period, race, insurance, age and ADI. ADI is a validated dataset that ranks census block groups based on socioeconomic deprivation (SED). Chi-square and Wilcoxon rank sum test were used to compare categorical and continuous variables by receipt of mammography. A multivariate logistic regression was used for associations between mammogram completion and the predictor variables. Results: A total of 694 patients were deemed eligible for BC screening in the year of 2019 (394) and 2020 (300). During the follow up period, only 106 and 30 patients from the pre-COVID-19 and COVID-19 cohorts underwent BC screening, respectively. During the pandemic, 30/30 patients who completed their screening were African Americans and had a high SED. In a multivariable analysis, COVID-19 period is associated with 79% lower odds of mammogram completion (OR 0.21; 95% CI 0.13, 0.35). ADI and race were not associated with higher screening rates. Medicaid status is associated with higher odds of mammogram completion (OR 1.97; 95% CI 1.12, 3.47). Conclusions: COVID-19 caused significant disruption in BC screening. In an area with high SED and high COVID-19 infection rates, private insurance holders and white patients had low rates mammogram completion. One potential explanation is that these patients sought care elsewhere. [Table: see text]

The Rapunzel syndrome describes a disorder in which a significant amount of hair is swallowed, forming a trichobezoar that extends past the stomach into the small intestines. Given the indigestible nature of hair, it subsequently leads to obstruction within the gastrointestinal system. Clinically, patients may present with symptoms of gastrointestinal obstruction, including abdominal complaints such as pain, nausea, vomiting, and diarrhea. However, due to its broad and nonspecific presenting symptoms, the diagnosis of Rapunzel syndrome warrants consideration once other common etiologies have been excluded. Surgical intervention is often required to remove the abdominal mass. This unusual syndrome is often associated with psychiatric disorders, affecting young women most commonly. In this report, we will discuss a unique case of Rapunzel syndrome in a one-month postpartum woman.

216 Background: Although colorectal cancer (CRC) screening with colonoscopy reduces the risk of CRC mortality, screening rates remain low among African Americans and low social economic status (SES) patients. However, few studies have assessed CRC screening rates in under-resourced hospital service areas. Using a granular measure of socioeconomic deprivation (SED), we examined the association between social determinants and CRC screening. Methods: We conducted a retrospective cohort study from 2014-2019 to identify primary care patients referred for CRC screening with colonoscopy at an academic hospital system. Patients were assessed at annual visits for completion of colonoscopy. SED was assessed using the area deprivation index (ADI), a composite measure of 17 SED indicators including income, housing, education, and employment at the census block group level. Other social determinants analyzed were race and insurance status. Frequency and multivariable logistic regression were used for statistical analysis. Results: 1040 patients met CRC screening guidelines and were referred for colonoscopy. 136 (13.1%) underwent colonoscopy in the follow-up period. High and low SED made up 655 (63%) and 77 (7.4%) of patients, respectively. SED, race, age, and sex were not associated with higher screening rates. Uninsured patients had a lower rate of screening. After controlling for other social determinants, uninsured patients had the lowest odds of colonoscopy (OR 0.28; 95% CI, 0.08-0.92). Conclusions: In this under-resourced hospital service area, receipt of colonoscopy for CRC screening is significantly lower than previously reported. Furthermore, screening rates were persistently low across strata of SED, race and insurance status, with uninsured patients having the lowest odds of screening. These data suggest that in an under-resourced hospital service area with extensive SED, further research is needed to understand the role of social determinants and behavioral factors to address disparities in CRC screening with colonoscopy. [Table: see text]

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