Community Uptake of an Online CRC Risk Assessment

Abstract

Purpose: Colorectal cancer (CRC) screening is underutilized. Major barriers include lack of physician recommendation or poor understanding of personal risk. We created an online CRC risk assessment incorporating family and personal history of adenomatous polyps and CRC which created a family tree, personalized risk score and screening recommendations based on ACG guidelines. Modifiable lifestyle factors were assessed and recommendations provided to minimize risk due to those factors (BMI, diet, smoking, physical activity). We sought to assess the feasibility and uptake of this tool. Methods: The risk assessment was created for CRC awareness month. Survey invited participants to complete questions on demographics, previous use of CRC screening, and family and personal history of polyps and CRC in 3 generations. Height weight, age > or < 50, race, quantified smoking exposure, physical activity, and dietary habits were assessed. Results: 3515 participants completed the risk assessment. 67% of participants were male, 81% white and 46% were under the age of 50. The mean BMI was 28.4. 53% reported eating < 3 servings of fruits and vegetables daily and 45% did not exercise at least 30 minutes 3-4 days per week. 61% of individuals reported never smoking and 28% were former smokers. 39% of individuals underwent previous screening with 89% of them reporting colonoscopy use. 11% of the population reported a history of adenomatous polyps and 1.3% reported CRC. The 405 indivdiduals who reported polyps/CRC had a higher BMI 29.6 vs. 28.1 (p= 0.013); age over 50 19% vs. 6% (p < 0.001); greater current packs of cigarettes (p = 0.024) and years of current smoking (p=0.032). Multivariable regression analysis (Table 1)confirmed that age, BMI and FDR with adenomatous polyps and cancer were associated with an increased OR for colorectal neoplasia. The risk score (Table 2), based upon the personal and family history provided revealed that 65% of the population was average risk, 11% low risk, 22% medium risk and 2% high risk. Self reported use of screening was associated in multivariable analysis to be associated with increased dietary intake of fruits/vegetables (3-5 vs. <3 servings daily 1.8 (1.4-2.3, p< 0.0001), FDR with CRC 2.2 (1.6-3.2, p<0.0001) and sibling with CRC 4.2 (2.3-7.7, p=0.0001). Conclusion: An online risk assessment tool is a feasible modality to provide consumer driven education regarding CRC risks and appropriate screening measures according to ACG guidelines. Whether the tool increases uptake of CRC screening is not known.Table: Factors associated with reported personal Hx CRC/polypsTable: Risk factors, risk score and screening recommendations