Results from a Colonoscopy Based Screening Program for the Uninsured: A Pilot Study from South Carolina

Abstract

Purpose: The purpose of our study was to screen through colonoscopy a racially diverse, uninsured population in rural South Carolina (SC). Methods: 150 patients aged 42 to 64 years were recruited from four free medical clinics and one federally qualified health center in 2008 and 2009. Participants were residents of rural counties in South Carolina. We targeted four counties because of the high incidence of colorectal cancer within this region. The screening program was made possible by a grant from the Blue-Cross BlueShield Foundation of South Carolina and a partnership between the SC Gastroenterology Association and the Center for Colon Cancer Research at USC. Each patient underwent a screening colonoscopy by a board certified gastroenterologist, at no charge to the patient. Participants completed a brief questionnaire addressing basic demographic characteristics, medical history and family history of polyps and/or colorectal cancer. To assess the association between colorectal lesions and personal risk factors, we estimated risk ratios and 95% confidence intervals for one or more adenomas using generalized linear regression analyses using a logarithmic linkage and a Poisson distribution adjusted for age and gender. Results: The average age of subjects was 55.2 years (SD 4.9), 30% were male, and 54% were African American (AA). The majority of our participants were unemployed (70%) and almost all were uninsured (98.5%). 13% of patients reported a family history of colorectal polyps and 25% reported a family history of colorectal cancer. Overall, we observed that 36.5% of patients had at least one adenoma while 14% had at least one hyperplastic polyp. We found that women had a non-significantly lower risk of adenomas compared to men. AAs compared to Caucasians were more likely to have a greater number of adenomas (RR 1.23 (95% CI 0.79-1.93)), and more advanced histology neoplasms (RR 3.21 (0.92-11.19)) and were less likely to have hyperplastic polyps (RR 0.32 (95% CI 0.13-0.78). We observed that a family history of colorectal polyps (RR 1.84 (95% 1.05-3.20)) or colorectal cancer (RR 1.53 (95% CI 0.95-2.47) was associated with an increased risk of adenomas compared to those reporting no family history of colorectal neoplasia. Conclusion: Our study demonstrates that a colonoscopy based screening program in a racially diverse and medically underserved cohort is feasible. Furthermore, we found that AAs and those with a family history of colonic polyps or cancer are at increased risk of colorectal neoplasia. Our results point to the importance of the index colonoscopy and availability of follow-up surveillance exams to reduce the incidence of colorectal cancer in South Carolina and beyond.