Abstract
BackgroundAdherence to colorectal cancer screening in the United States is suboptimal, particularly in medically underserved populations due to significant barriers to care. Unique accessible, low-cost, and non-invasive screening tests for this population could greatly benefit current rates. In this article, we assess patient preference and the impact of offering a blood-based test on screening rates in a cost-free health fair setting from April 2017 to April 2019.MethodsParticipants who met colorectal cancer screening eligibility criteria set forth by the United States Preventive Services Task Force were recommended to attend the colon cancer screening station. Those participants who elected to attend were offered various, accepted screening methods, and if they declined, were offered alternative blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes.ResultsOf 1401 participants who were recommended to attend, 640 (45.7%) participants were evaluated at the colon cancer screening station, of whom 460 were eligible for testing. Amongst these, none selected colonoscopy, 30 (6.5%) selected fecal immunochemical testing, and 430 (93.5%) selected blood-based testing. Only 2 participants returned the fecal immunochemical tests. In the blood test cohort, 88 were positive and 20 received a follow up colonoscopy.ConclusionsBased on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.
Highlights
Adherence to colorectal cancer screening in the United States is suboptimal, in medically underserved populations due to significant barriers to care
Routine screening for Colorectal cancer (CRC), such as with colonoscopy and fecal immunochemical testing (FIT), at regular intervals leads to earlier CRC detection, lower CRC incidence and mortality, and overall cost savings compared to no screening [2,3,4]
Given the potential for a blood-based test to improve screening rates for medically underserved populations (MUP), we developed a program to assess the impact of adding methylated SEPT9 DNA (mSEPT9) testing to our CRC screening station at the Department of Community Service (DOCS) health fairs
Summary
Adherence to colorectal cancer screening in the United States is suboptimal, in medically underserved populations due to significant barriers to care. In the United States, the most utilized method for CRC screening is colonoscopy, but it is not necessarily an ideal screening tool in MUP given its cost, invasiveness, risk, lack of convenience and accessibility, and patient perception [8, 9]. Some characteristics of a MUP, such as low income, lack of insurance or being underinsured, and lack of a primary care provider (PCP), make screening an even bigger challenge for this group. This is the case for access to colonoscopy
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