Abstract IA28: Colorectal cancer screening and diagnostic services for urban and rural safety-net-settings

Abstract

Abstract Background: Colorectal cancer (CRC) is a leading cause of cancer mortality and a relatively common cancer diagnosis in the United States. CRC screening is effective and cost-effective for reducing mortality. Screening rates for CRC, while increasing, are lower than for many other cancer screening tests. There is a clear benefit to early detection. Early stage CRC is often treatable, with five year survival rates over 90%. Later stage CRCs are associated with poorer outcomes. Furthermore, CRC Screening is notable in its ability to prevent cancers through the detection and removal of pre-cancerous polyps. There are several USPSTF-recommended options for screening. Cancer health disparities are evident in CRC. Under- or un-insured and lower income adults generally have lower rates of screening, later stage at diagnosis, and poorer survival outcomes. Many of these adults seek care in the healthcare “safety-net”, including federally qualified health centers. Such settings themselves are often under-resourced. Methods: Our team has studied CRC screening from multiple perspectives in the safety-net setting across several studies. Most recently, we conducted a cluster randomized trial to promote CRC screening across several rural and urban health centers. The trial applied principles of community-based participatory research and intervened at the patient and provider/clinic levels. Implementation outcomes were monitored and recorded. Findings: Implementation of screening and screening programs in safety-net settings face unique challenges and researchers need to be aware of the context in which these patients are seeking and receiving their healthcare. Given the high cost of diagnostic follow-up for positive FOBT/.FIT, and the costs of colonoscopy even for screening, many safety-net patients face barriers to screening and follow-up. This talk will explore the cross-section of health disparities research and implementation and dissemination research, highlighting data from community-engaged research and community-clinical-academic partnership in the Program for the Elimination of Cancer Disparities, an NCI-funded community networks program center. Citation Format: Aimee S. James. Colorectal cancer screening and diagnostic services for urban and rural safety-net-settings. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA28.