Average Risk For Colorectal Cancer Research Articles

S0542 Intraoperative Morbidity Associated With Monitored Anesthesia Care in Obese Patients Undergoing Average Risk Colorectal Cancer Screening

INTRODUCTION: Average risk Colorectal Cancer (CRC) screening colonoscopy requires procedural sedation and monitored anesthesia care (MAC). Elevated BMI is associated with higher prevalence of comorbid conditions including obstructive sleep apnea, hypertension, and pulmonary hypertension. Pre-existing comorbidities, including obesity, may be associated with increased intraoperative cardiopulmonary (ICP) morbidity related to procedural sedation. The aim of our quality improvement project was to evaluate intraoperative morbidity associated with MAC during screening colonoscopy in obese patients. METHODS: Data were collected by retrospective chart review of 304 randomly selected patients undergoing average risk CRC screening colonoscopy at Allegheny Health Network. Demographic data for obese (n = 152) and non-obese (n = 152) cohorts were collected (Table 1). BMI and intraoperative indices including arrhythmia, hypotension, and oxygen saturation, were extracted and analyzed using Pearson’s Chi-Squared Test. Independent T-Test was performed to compare average oxygen desaturation time (ODT). RESULTS: 77.3% of patients were BMI 25–29.9 (27.3%), 30–40 (25.3%) and ≥40 (24.7%) (Table 1). 52.6% of obese patients experienced oxygen desaturation (SaO2 < 95%) as compared to 46.7% in non-obese patients, but this was not statistically significant. Obese patients did have lower mean initial SaO2 and statistically significant increased time with SaO2 < 95% (P = .007). There was no statistically significant association between obesity and intraoperative complications including hypotension, arrhythmia, and hypoxia. CONCLUSION: Our study shows no statistically significant difference in ICP morbidity related to obesity(BMI >30), except for ODT. These findings suggest that patients with obesity are at higher risk of prolonged oxygen desaturation during MAC assisted colonoscopies. Further larger studies are needed to evaluate the clinical implications of prolonged ODT in obese patients.Table 1.: Patient demographics and comorbiditiesTable 2.: Rates of intraoperative cardiopulmonary complications in obese and non-obese patients while under MAC during screening colonoscopyTable 3.: A and 3B. 3A: T-test for Equality of Means showing statistically significant increased ODT minutes in obese patients; 3B: Obese vs. Non-Obese Group Statistics for intraprocedural oxygenation status

S0280 Lowering the Colorectal Cancer Screening Age Improves Predicted Outcomes in Pre-Medicare and Medicare Populations in the CRC-AIM Microsimulation Model

INTRODUCTION: Most US guidelines recommend average risk colorectal cancer (CRC) screening for ages 50–75. An increasing CRC incidence among younger populations renders critical the need to evaluate the potential benefit of earlier CRC screening initiation. Using the validated CRC-AIM microsimulation model, we estimated the impact of lowering the CRC screening initiation age on outcomes for triennial multitarget stool DNA (mt-sDNA) or annual fecal immunochemical test (FIT) screening strategies. METHODS: Screening strategies were simulated for individuals free of diagnosed CRC at age 40 and screened from ages 50–75 or 45–75. CRC incidence, mortality, and life-years gained (LYG) were assessed for pre-Medicare eligible and Medicare eligible years (ages 65–75). Adherence rates were assumed to be as previously reported (71% for mt-sDNA vs 43% for FIT) or perfect (100%). Predicted outcomes of screening vs no screening are per 1000 individuals. Statistical differences between ages 45 and 50 were assessed by McNemar’s test. RESULTS: For individuals who initiated screening at age 45 with reported adherence, triennial mt-sDNA and annual FIT resulted in 23.9 and 24.4 more predicted LYG, respectively, versus starting screening at age 50 (Figure 1). With reported adherence, reductions in CRC incidence with mt-sDNA were 64.5% and 61.1% at screening start ages of 45 and 50, respectively, and with FIT were 53.7% and 49.9% (both P < 0.0001). Reductions in CRC mortality with mt-sDNA were 71.7% and 68.7% at screening start ages of 45 and 50, respectively, and with FIT were 62.7% and 59.0% (both P < 0.0001). Reductions in CRC cases and deaths were observed for both pre-Medicare and Medicare populations (Figures 2-3). With reported adherence, the number of CRC cases and deaths were lower with triennial mt-sDNA than annual FIT regardless of screening start age. Improvement in outcomes with earlier screening initiation were greater when assuming reported versus perfect adherence. CONCLUSION: Non-invasive stool-based screening tests may serve as effective early screening tools among younger populations. LYG and reductions in CRC incidence and mortality are greater when beginning screening at age 45 vs age 50, with gains applying to both pre-Medicare and Medicare populations. CRC outcomes were improved with a lower initiation age for both reported and perfect adherence model assumptions. When assuming reported adherence rates, mt-sDNA confers greater benefits than FIT.Figure 1.: Life-years gained (LYG) with triennial mt-sDNA and annual FIT assuming reported or perfect adherence and screening start ages of 45 or 50 years.Figure 2.: CRC cases per 1000 individuals with triennial mt-sDNA and annual FIT assuming reported or perfect adherence and screening start ages of 45 or 50 years. Results are shown for the pre-Medicare eligibility years (ages 45– or 50–64) or during Medicare eligibility (ages 65–75).Figure 3.: CRC deaths per 1000 individuals with triennial mt-sDNA and annual FIT assuming reported or perfect adherence and screening start ages of 45 or 50 years. Results are shown for the pre-Medicare eligibility years (ages 45– or 50–64) or during Medicare eligibility (ages 65–75).

Colorectal cancer screening completion: An examination of differences by screening modality.

Average-risk colorectal cancer (CRC) screening is broadly recommended, using one of several endorsed test options. However, CRC screening participation rates remain below national goals. To gain further insights regarding recent, population-based patterns in overall and test-specific CRC screening participation, we conducted a retrospective study of adults, ages 50–75 years, utilizing comprehensive data resources from the Rochester Epidemiology Project (REP).Among residents of Olmsted County, MN eligible and due for CRC screening, we identified 5818 residents across three annual cohorts who completed screening between 1/1/2016 and 12/31/2018. We summarized CRC screening rates as incidence per 1000 population and used Poisson regression to test for overall and mode-specific CRC trends. We also analyzed rates of follow-up colonoscopy within 6-months after a positive stool-based screening result.While no significant differences over time were observed in overall CRC screening incidence rates among those due for screening, we observed a statistically significant increase in mt-sDNA test and statistically significant decreases in screening colonoscopy and FIT/FOBT test completion rates; differences in screening overall and by modality were observed by age, sex, and race/ethnicity. The diagnostic colonoscopy follow-up rate within six months after a positive stool-based test was significantly higher following mt-sDNA (84.9%) compared to FIT/FOBT (42.6%).In this retrospective, population-based study, overall CRC screening incidence rates remained stable from 2016 to 2018, while test-specific rates for mt-sDNA significantly increased and decreased for colonoscopy and FIT/FOBT. Adherence with follow-up colonoscopy after a positive stool-based test was significantly higher among patients who underwent mt-sDNA screening compared to FIT/FOBT.

Abstract 3501: Lower perceived colorectal cancer risk is associated with less aerobic physical activity in Latino adults

Abstract INTRODUCTION: Engaging in aerobic physical activity (PA) has been linked to reduced risk of adverse health outcomes, such as colorectal cancer (CRC). Despite known benefits of engaging in aerobic PA, Latino adults have a low prevalence of aerobic PA compared to other racial/ethnic groups. Limited research has examined the relationship between perceived risk of CRC and aerobic PA among Latinos. Therefore, the purpose of our study was to examine perceived risk of CRC and aerobic PA among US Latino adults. METHODS: We used cross-sectional 2015 National Health Interview Survey (NHIS) data on Latino participants ≥18 years of age (n=5,457). Perceived CRC risk was assessed based on self-reported measures to which participants responded whether they considered themselves at less than average risk, average risk, or higher than average risk for CRC. Aerobic PA was measured based on self-reported minutes of moderate-to-vigorous aerobic activity per week, which were categorized into none (0 min/week), some aerobic PA (&amp;gt;0 min/week of activity but less than recommendation), and meeting the aerobic activity guideline (≥150 min of moderate-vigorous PA or ≥75 min of vigorous PA or 150 min of moderate PA/week). Multinomial logistic regression models that accounted for complex survey design of NHIS were used to estimate the associations between perceived risk of CRC (ref= less than average risk) with aerobic PA (ref= none). All models were adjusted for age, sex, education, insurance, and nativity. RESULTS: In adjusted models, compared with individuals who perceived themselves at higher than average risk, those who perceived themselves at less than average risk for CRC were significantly less likely to engage in some aerobic activity (Odds Ratio [OR]: 0.63, 95% Confidence Interval [CI]: 0.40-0.99). In addition, those who perceived themselves at average risk for CRC were also significantly less likely to engage in some aerobic activity (OR 0.60, 95% CI: 0.37-0.96). CONCLUSION: These findings suggest that perceived CRC risk is associated with aerobic activity among Latino adults. CRC prevention efforts should consider the role of perception of CRC risk in the promotion of physical activity among Latinos. Citation Format: Pooja Agrawal, Jocelyn Yanez, Rosenda Murillo. Lower perceived colorectal cancer risk is associated with less aerobic physical activity in Latino adults [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3501.

Colorectal Neoplasia among Patients with and without Human Immunodeficiency Virus.

Increasing availability of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) has led to prolonged survival and rising incidence of non-HIV-defining cancers among patients with HIV. Compared with the general population, risk of colorectal cancer may differ among those with HIV due to immunosuppression, oncogenic viral coinfections, and higher prevalence of risk factors. We identified patients (age ≥50 years) diagnosed with HIV, prescribed HAART for ≥6 months, and receiving care in two large health care systems in Dallas, TX. Patients received a first colonoscopy between January 2009 and December 2017. We calculated a standardized prevalence ratio as the ratio of observed to expected number of advanced neoplasia (high-risk adenoma or colorectal cancer) using an age- and sex-matched cohort of patients without HIV (n = 10,250). Among patients with HIV (n = 839), about two thirds (60.1%) had normal findings at colonoscopy; 6.8% had hyperplastic polyps only, 20.4% had low-risk adenomas, 11.7% had high-risk adenomas, and 1.1% had colorectal cancer. Prevalence of advanced neoplasia was similar between patients with and without HIV, with a standardized prevalence ratio of 0.99 (95% confidence interval, 0.81-1.19). There was no difference in the prevalence of colorectal neoplasia between patients with and without HIV. Patients with HIV appear to have similar risk of colorectal neoplasia compared to those without HIV and can therefore follow average-risk colorectal cancer screening guidelines.

Comparison of Tissue-Based Molecular Markers in Younger versus Older Patients with Colorectal Neoplasia.

Emerging colorectal cancer trends demonstrate increased incidence and mortality in younger populations, prompting consideration of average-risk colorectal cancer screening initiation at age 45 versus 50 years. However, screening test performance characteristics in adults 45-49 years have been minimally described. To inform the biologic rationale for multi-target stool DNA (mt-sDNA) screening in younger patients, we analyzed and compared tissue levels of methylation (BMP3, NDRG4) and mutation (KRAS) markers included in the FDA-approved, mt-sDNA assay (Cologuard; Exact Sciences Corporation). Within 40-44, 45-49, and 50-64 year age groups, archived colorectal tissue specimens were identified for 211 sporadic colorectal cancer cases, 123 advanced precancerous lesions (APLs; adenomas >1 cm, high-grade dysplasia, ≥25% villous morphology, or sessile serrated polyp; 45-49 and 50-64 age groups only), and 204 histologically normal controls. Following DNA extraction, KRAS, BMP3, and NDRG4 were quantified using QuARTS assays, relative to ACTB (reference gene). None of the molecular marker concentrations were significantly associated with age (P > 0.05 for all comparisons), with the exception of NDRG4 concentration in APL samples (higher in older vs. younger cases; P = 0.008). However, NDRG4 levels were also statistically higher in APL case versus normal control samples in both the 45-49 (P < 0.0001) and 50-64 (P < 0.0001) year age groups. Overall, these findings support the potential for earlier onset of average-risk colorectal cancer screening with the mt-sDNA assay. These novel data address an identified knowledge gap and strengthen the biologic basis for earlier-onset, average-risk screening with the mt-sDNA assay.

COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing—A New Paradigm Shift

ABSTRACT Colorectal cancer is the third leading cause of cancer related deaths and to date, the COVID-19 pandemic has led to major disruptions of the diagnosis and treatment pathways of this cancer, which may adversely affect survival outcomes for many years. Colorectal cancer pathways must be maintained at a near normal throughput with urgent attention to the backlog of patients to avoid a potential crisis of avoidable cancer deaths. A radical review and revamping of endoscopy services to improve efficiency during COVID-19 is urgently required. To date most endoscopy units have severely restricted their activity, except for time-critical diagnostic and therapeutic procedures. In the post- COVID-19 recovery phase, access to endoscopy services will increase but capacity will be reduced compared to before the pandemic, due to infection control measures. A pragmatic and safe strategy is urgently needed to clear the backlog of endoscopic procedures and for managing the new symptomatic referrals. We propose the use of non-invasive tests, such as FIT and mSEPT9 combined with “safety netting” to “rule out” colorectal cancer and to reduce the utilization of colonoscopy by up to 80% and limit the procedure to those patients at high risk of cancer.

Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties

Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties

Efficacy of the population-based pilot colorectal cancer screening, Csongrád county, Hungary, 2015

Background/aim In Hungary, a nationwide colorectal screening program is about to be introduced in order to improve the high mortality rate of colorectal cancer (CRC). The aim was to summarize experiences from and assess short-term efficacy of the population-based pilot colorectal screening program in 2015 in Csongrád county, Hungary. Materials and methods Asymptomatic individuals between the ages of 50 and 70 with average risk of colorectal cancer participated in the program that was based on the two-step screening method: immune fecal blood test and colonoscopy. The short-term efficacy was assessed as the change in total CRC incidence and initial tumor stage in the screening year (2015). Results 22,130 individuals were invited to participate, and the participation rate was 46.4%. Immune fecal blood test proved to be nonnegative in 1,343 cases (13%), screening colonoscopy was performed in 766 of them (7.5%). Total colonoscopy was performed in 711 individuals. Based on the reports, adenoma was detected in 358 (50.3%) and malignancy in 42 (5.9%) individuals. In the background population, the incidence of colon cancer was higher (183 vs. 228; P = 0.026) and was diagnosed at earlier stage (P = 0.002), while lymph node involvement was lower in 2015 (48.3% vs. 37.1%; P = 0.049). Conclusion The Csongrád county population-based colorectal cancer screening was evidently successful on the short-term considering participation rate, and the changes in CRC incidence and stage, thus its national extension is necessary.

Abstract C120: Evidence-based strategies to enhance colorectal cancer screening in American Indian communities

Abstract Despite the proven effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have some of the lowest CRC screening rates. Nearly two-thirds of US adults are current with US Preventive Services Task Force guidelines for CRC screening. In contrast, based on Indian Health Service (IHS) Government Performance and Results Act (GPRA) data, AI screening rates range from a low of 28% in the Phoenix Area, to 30% in the Albuquerque Area and a high of only 51% in the Oklahoma Area. The AI CRC Screening Consortium was formed by the National Cancer Institute-Designated Cancer Centers at the Universities of Arizona, New Mexico, and Oklahoma to address the major regional CRC screening disparities. The Consortium’s overall objective is to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC through the implementation of cost-effective multilevel, multicomponent evidence-based interventions (EBIs) across AI populations (on and off tribal lands) in the tri-state region. As part of the planning phase of the project (Year 1), we completed mixed-methods environmental scans (focus group and interviews, and readiness to change surveys) among tribal members and multisector healthcare providers practicing at Indian Health Service (IHS, I), Tribal (T), and Urban Indian (U) (I/T/U) healthcare facilities across the three states. In all, we conducted seven focus groups, 71 interviews, and three surveys at nine I/T/U healthcare facilities. We organized the focus group and interview data according to The Guide to Community Preventive Services (The Community Guide) recommendations for strategies to increase: community demand, community access, and provider delivery of CRC screening. We will provide quotes and summaries underscoring the EBIs and strategies recommended by the multisector healthcare action teams for implementation at their healthcare facilities. We will also describe the establishment of the Consortium and challenges experienced in conducting research with multiple tribal and federal entities and regulatory authorities. The use of community-academic participatory approaches has facilitated bidirectional and mutually beneficial knowledge integration, collaborative inter-dependent partnerships, equity in data ownership, and capacity enhancement. The scope of this project presents an opportunity to reduce CRC incidence and mortality affecting thousands of AIs. Our collaborative work will create opportunities for future research addressing the spectrum of CRC prevention, detection, and treatment in AI populations across the US. Citation Format: Shiraz I Mishra, Mark P Doescher, Jennifer Hatcher, Kevin English, Dorothy Rhoades, Peter Lance, Shane Pankratz, Jessica Blanchard, Nicholas Edwardson, Michelle Hopkins, Andrew Sussman, Zsolt Nagykaldi, Cheyenne Jim. Evidence-based strategies to enhance colorectal cancer screening in American Indian communities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C120.

Tu1116 DISPARITIES IN HEALTH: LOWER COLORECTAL CANCER SCREENING RATES AMONG LGBTQ PATIENTS

Colorectal cancer (CRC) screening via colonoscopy can prevent CRC. Socially neglected populations such as ethnic and racial minorities have consistently lower CRC screening rates when compared to the general population. While lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients represent a population who are at risk for CRC screening disparities, an estimate of the existence and magnitude of the disparity remains unknown. The aim of this study is to analyze the rate of CRC screening between the LGBTQ population and the general population to determine if a disparity exists along with the possible magnitude. Data was extracted from our tertiary care medical center’s de-identified patient database (SD) between 2014 and 2018. Search terms for the LGBTQ population included self-identification in the EMR as “lesbian”, “gay”, “bisexual”, “transgender”, “transsexual”, “queer”, “questioning”, or “intersex” or had an associated ICD 9 or 10 code. The 2008 USPSTF criteria for CRC screening were utilized for identification of patients eligible for screening. Search terms for average risk CRC screening included “colonoscopy”, “FOBT”, “FIT”, “flexible sigmoidoscopy”, and ICD 9/10 codes v76.51, v76.41, z12.11, and z12.12. Patients considered as increased risk for CRC were excluded (family history of CRC or advanced polyp; personal history of IBD). Based on the magnitude of data for the general population, the Center for Disease Control (CDC) and Prevention database for our state was utilized in publication years to calculate the CRC screening rate of the state-wide population. Students t-test for was utilized to assess for differences between the groups. A total of 117 LGBTQ patients were found in the SD. 15% were lesbian, 44% gay, 18% bisexual, 23% transgender, and 0% queer/questioning or intersex with a mean age of 58 [50-76] years-old. 85% were Caucasian (90% non-Hispanic; 3% Hispanic; 7% not identified), 11% African-American, 0% Asian, and 4% unknown. Of the LGBTQ patients identified, 35 met 2008 USPSTF eligibility criteria for average risk CRC screening. The LGBTQ CRC screening rate compared to the state population rate was 29.3% v. 64.9% (p<0.01) in 2014, 34.8% v. 66.4% (p<0.01) in 2016, and 29.9% v. 69.1% (p<0.01) in 2018. Despite increased CRC screening rates for the state population over the years of the study, the rate among the LGBTQ population remained low. Although this is a single center study, our data may serve to highlight low CRC screening rates among the LGBTQ population. Future studies to evaluate the etiology of the low rate, barriers to screening in this marginalized population, and implementation of strategies to improve screening rates are underway.

Abstract C108: Sociodemographic determinants of colorectal cancer screening completion among women adherent to mammography screening guidelines

Abstract Background Several initiatives have focused on increasing colorectal cancer (CRC) screening rates, but national rates still fall below 70% for many groups, particularly those in underserved communities. Examining CRC screening determinants in groups who have completed screening for other cancer sites may provide useful information to support future initiatives. In 2015, 71.6% of women nationally completed mammograms in the past two years, while only 63% completed any CRC screening procedures. Purpose We examined data from the 2015 National Health Interview Survey to identify determinants of CRC screening completion among women adherent to breast cancer (BrCa) screening guidelines. We hypothesized that race, income, and psychosocial factors would explain CRC screening non-adherence. Methods The sample contained women (N=1206), aged 50-74 years, BrCa free, who completed a mammogram in the past two years, and were of average CRC risk (no first degree relative with cancer, history of polyps or inflammatory bowel disease). Bivariate associations between sociodemographic, health access, perceived BrCa risk, perceived CRC risk variables, and CRC screening status were examined using chi-square tests. Multivariate logistic regression analysis was used to examine factors associated with CRC screening completion. Results Prevalence of CRC screening in this sample was 55.52% including: Sigmoidoscopy (1.47%), colonoscopy (50.33%), fecal occult blood test (10.81%). Significant differences in CRC screening (p &amp;lt;.01) by education, income, insurance, foreign birth status, and language regularly spoken were revealed. Having insurance (OR:4.52, CI:2.20-9.31) and being foreign-born (OR: 1.77, CI:1.17-2.66) were independently associated with CRC screening completion after controlling for all other factors. Conclusion CRC screening rates among women completing breast cancer screening were lower than the national average for women. Neither perceived BrCa risk nor perceived CRC risk explained CRC screening behavior. Income and health insurance variables appear to drive sociodemographic differences in screening completion. However, foreign-born status had a direct impact on CRC screening behavior. Differences in the availability of free or low-cost screening programs for BrCa and CRC may explain these findings. More research is needed to understand how sociodemographic factors interact to impact CRC screening rates in this group. Citation Format: Deeonna E Farr, Leslie E Cofie, Alison T Brenner, Ronny A Bell, Daniel S Reuland. Sociodemographic determinants of colorectal cancer screening completion among women adherent to mammography screening guidelines [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C108.

PCN148 BUDGET IMPACT OF IMPROVING ADHERENCE TO COLORECTAL CANCER SCREENING

Screening is essential to the prevention, early detection, and successful treatment of colorectal cancer (CRC). Providing options, including non-invasive modalities increases uptake of CRC screening. In order to maximize the benefit of screening, stakeholders must consider the probability that eligible patients will or will not screen. With the aim of examining the clinical and economic consequences of varying adherence levels, a budget impact model was developed from the payer and integrated delivery network (IDN) perspectives. Over a 10-year time horizon, mt-sDNA utilization increased from 6% to 28% among those screened by mt-sDNA, FIT and colonoscopy. The payer perspective included direct medical costs, such as stool-based tests, procedures, adverse events, and CRC treatment. In addition to CRC screening program costs, the IDN perspective also included all the aforementioned costs, with the exception of stool-based tests. Worst- and best-case adherence scenarios based on published estimates were simulated. For mt-sDNA, FIT, and colonoscopy, initial screening uptake ranged from 67.5%-71.1%, 48%-64.7%, and 38%-64%, whereas repeat adherence ranged from 54%-86.1% for stool-based screening and from 38%-64% for colonoscopy. Follow-up diagnostic colonoscopy adherence for non-invasive screening ranged from 55.6%-98.6%. With a hypothetical population of 1 million members and an assumed screening eligible population of ages 50-75 at average risk for CRC, best- and worst-case adherence scenarios yielded approximately 11,000 and 19,000 fewer colonoscopies compared to the status quo. The payer savings ranged from $3M-$6M with $0.02-$0.05 per-member-per-month (PMPM) and the IDN incurred savings from $16M-$31M with $0.13-$0.26 PMPM for the best- and worst-case compliance adherence scenarios. Due to the decrease in screening and surveillance colonoscopies as well as related adverse events, increased mt-sDNA use may lead to significant averted costs for payers and IDNs. Although increased adherence decreases aggregate averted costs, savings may persist with increased mt-sDNA use.

A Teachable Moment: Colorectal Cancer Screening Among Companions Waiting for Outpatients Undergoing a Colonoscopy.

To determine colorectal cancer (CRC) screening knowledge, attitudes, behaviors, and preferences for a future CRC screening educational intervention among adults (companions) waiting for outpatients undergoing a colonoscopy. We approached 384 companions at three endoscopy centers associated with one healthcare system to complete a survey from March to July 2017. The survey assessed CRC and CRC screening knowledge, attitudes, behaviors, and preferences for a future CRC screening educational intervention. There were 164 companions at average risk for CRC that completed a self-administered survey. Among average-risk companions, 23% were not within screening guidelines. Additionally, 74% of those not within guidelines reported that they had never completed a CRC screening test. The most frequently reported barriers to CRC screening were the perception of not needing screening because they were asymptomatic and lack of a provider recommendation for screening. Companions suggested that a future CRC screening intervention include a brochure and/or a brief video, featuring men and women from different races/ethnicities, a CRC survivor, and a healthcare professional. Almost one-fourth of average-risk companions waiting at endoscopy centers were not within CRC screening guidelines, providing a teachable moment to recruit companions to participate in an educational intervention to encourage screening. Companions provided suggestions (e.g., content and channel) for a future intervention to promote CRC screening in this population.

A27 INCREASING INCIDENCE OF COLORECTAL CANCER IN ADULTS UNDER AGE OF 50 IN ALBERTA

Abstract Background Overall colorectal cancer (CRC) incidence has been decreasing in Canada since the early 2000s, most likely due to increased use of colorectal cancer screening for adults over the age of 50. However, the incidence of CRC may be rising in adults younger than age 50 both in Canada and the USA. The American Cancer Society in 2018 issued a qualified recommendation that people with an average risk of CRC should start screening at age 45. The burden of CRC in adults under the age of 50 is not well-characterized in Alberta. Aims The aim of this study is to determine the incidence trends in colorectal cancer in adults under the age of 50 compared to those over the age of 50 in Alberta. Methods This cohort study determined the incidence of colorectal cancer in patients under the age of 50 compared to those over the age of 50 reported to the Alberta Cancer Registry (ACR) from 2010 to 2017. Annualized percentage changes (APCs) in incidence rate were estimated using the Joinpoint Regression Program 4.7.0.0 (Nation Cancer Institute). APCs in relative risk of CRC in different age groups compared to the 50–74 age group were also estimated in the same methodology. Results From 2010 to 2017 there were 17167 incident cases of colorectal cancer. Of these, 92% were in adults over the age of 50 while 8% were in those under the age of 50. For adults under the age of 50, incidence of CRC increased from 6 to 7.2 per 100,000 with a mean annual percentage change of 2.58% between 2010 and 2017. This is in contrast to adults over the age of 50, where the incidence of CRC decreased from 170 to 128 per 100,000 with a mean annual percentage change of -1.64% from 2010 to 2015 and -9.42% from 2015 to 2017. Compared to the 50–74 age group, the average relative risk of CRC in the 46–49 age group is 0.26 with an annual increase of 0.55%; while in the 40–45 age group the average relative risk of CRC is 0.15 with an annual increase of 2.61%. Conclusions Similar to national incidence trends, the incidence of CRC in adults under the age of 50 is increasing in Alberta. Although the overall incidence in this population is relatively low, suspicion of CRC in adults under age 50 can help prevent delays in diagnosis. Incidence of colorectal cancer in Alberta for adults under the age of 50 increased from 6 to 7.2 per 100,000 with a mean annual percentage change of 2.58% between 2010 and 2017. Funding Agencies None

Premature Fecal Immunochemical Testing in British Columbia Canada: a Retrospective Review of Physician and Screening Participant Characteristics.

Colorectal cancer (CRC) screening is an evidence-based strategy to reduce CRC-related mortality. This study identifies physician and participant characteristics, as well as previous FIT values associated with premature FIT usage. This is a retrospective review of all FITs ordered from January 1, 2016, until June 30, 2017. For each ordered FIT, the participant's chart was reviewed to identify if a previous FIT had occurred in the prior 21 months. A premature FIT was defined as an ordered test with a negative FIT in the preceding 21 months. Screening participants were average risk for CRC, aged 50-74, and had a FIT ordered by their primary care provider in British Columbia, Canada. The BC College of Physicians and Surgeons' database was used to identify the location of referring physician, date of graduation from medical school, and gender. The participant's age, gender, and value of previous FIT were recorded. Physician and participant variables and previous FIT value were examined with logistic regression to identify associations with premature FIT ordering. In total, 385,375 FITs were ordered during this period with 116,727 representing participants returning following a previous negative FIT. In total, 35,148 (30.1%) returned early for screening. Men were more likely to return early than women (OR 1.14; 95% CI 1.11-1.17; p < 0.0001). Male physicians were more likely to order premature FITs (OR 1.15; 95% CI 1.06-1.24; p < 0.0001). A higher quantitative FIT value (ng/mL) of the previous FIT was also associated with early screening (OR 1.11; 95% CI 1.09-1.14; < 0.0001). This study found that approximately 30% of FIT tests, ordered for CRC screening, were ordered before they were due. This may lead to wasted resources, unnecessary participant stress, and unwarranted patient risk.

Impact of Tailored Interventions on Receipt of a Preference-Concordant Colorectal Cancer Screening Test.

Background. Individuals at average risk for colorectal cancer (CRC) have multiple test options. Preference for a specific test modality may affect decision making about CRC screening. The current study examined 1) the sociodemographic and health belief characteristics of average-risk participants with a test preference for stool blood test (SBT) versus those with a preference of colonoscopy, and following receipt of a tailored CRC screening intervention, 2) the percentage of participants who completed a preference-concordant CRC screening test, and 3) the sociodemographic, health care experience, and health belief characteristics and intervention group(s) associated with completion of a preference-concordant screening test. Methods. Participants (N = 603) were female, aged 50 to 75 years, at average CRC risk, not currently up-to-date with CRC screening recommendations, had Internet access, and were randomized to receive 1 of 3 tailored CRC screening promotion interventions. Multivariable logistic regression analyses were conducted. Results. Most women (64%) preferred SBT, whereas 36% preferred colonoscopy. There were significant differences in test preference by age, stage of change for the specific tests, perceived benefits of CRC screening, perceived barriers to both tests, and self-efficacy for colonoscopy. Two hundred thirty participants completed CRC screening at 6 months post-intervention. Of those, most (84%) completed a test concordant with their preference. Multivariable analyses revealed that compared with participants completing a preference-discordant test, those completing a preference-concordant test were older (P = 0.01), had health insurance (P < 0.05), and were in the phone counseling-only group (P < 0.01). Conclusions. High levels of completion of preference-concordant CRC screening can be achieved by educating average-risk patients about the multiple screening test options, soliciting their preferences, and offering testing that is concordant with their preference.

Multitarget Stool DNA Test Performance in an Average-Risk Colorectal Cancer Screening Population.

INTRODUCTION:We set out to evaluate the performance of a multitarget stool DNA (MT-sDNA) in an average-risk colonoscopy-controlled colorectal cancer (CRC) screening population. MT-sDNA stool test results were evaluated against fecal immunochemical test (FIT) results for the detection of different lesions, including molecularly defined high-risk adenomas and several other tumor characteristics.METHODS:Whole stool samples (n = 1,047) were prospectively collected and subjected to an MT-sDNA test, which tests for KRAS mutations, NDRG4 and BMP3 promoter methylation, and hemoglobin. Results for detecting CRC (n = 7), advanced precancerous lesions (advanced adenoma [AA] and advanced serrated polyps; n = 119), and non-AAs (n = 191) were compared with those of FIT alone (thresholds of 50, 75, and 100 hemoglobin/mL). AAs with high risk of progression were defined by the presence of specific DNA copy number events as measured by low-pass whole genome sequencing.RESULTS:The MT-sDNA test was more sensitive than FIT alone in detecting advanced precancerous lesions (46% (55/119) vs 27% (32/119), respectively, P < 0.001). Specificities among individuals with nonadvanced or negative findings (controls) were 89% (791/888) and 93% (828/888) for MT-sDNA and FIT testing, respectively. A positive MT-sDNA test was associated with multiple lesions (P = 0.005), larger lesions (P = 0.03), and lesions with tubulovillous architecture (P = 0.04). The sensitivity of the MT-sDNA test or FIT in detecting individuals with high-risk AAs (n = 19) from individuals with low-risk AAs (n = 52) was not significantly different.DISCUSSION:In an average-risk screening population, the MT-sDNA test has an increased sensitivity for detecting advanced precancerous lesions compared with FIT alone. AAs with a high risk of progression were not detected with significantly higher sensitivity by MT-sDNA or FIT.

Promoting colonoscopy screening among low-income Latinos at average risk of colorectal cancer: A randomized clinical trial.

Screening colonoscopy (SC) for colorectal cancer (CRC) is underused by Latino individuals. The current randomized clinical trial examined the impact of 3 interventions: 1) patient navigation; 2) patient navigation plus standard Centers for Disease Control and Prevention print materials; and 3) patient navigation plus culturally targeted print materials for Latinos referred for SC. Demographic, personal and health history, and psychometric factors associated with SC also were examined. A total of 344 urban Latino individuals aged 50 to 85years with no personal and/or immediate family history of CRC diagnosed before age 60years, no personal history of a gastrointestinal disorder, no colonoscopy within the past 5years, with insurance coverage, and with a referral for SC were consented. Participants were randomized to patient navigation (20%), patient navigation plus standard Centers for Disease Control and Prevention print materials (40%), and patient navigation plus culturally targeted print materials (40%). The completion of SC was assessed at 12months. The interventions had an overall SC rate of 82%. Counterintuitively, patients with an average income of <$10,000 were found to have higher SC rates (87%) than those with a greater income (75%). The addition of standard or culturally targeted print materials did not appear to increase SC rates above those for patient navigation. Indeed, after controlling for other variables, culturally targeted print materials were found to be associated with lower SC rates among Puerto Rican individuals.

Ileal intubation is not associated with higher detection rate of right-sided conventional adenomas and serrated polyps compared to cecal intubation after adjustment for overall adenoma detection rate

BackgroundHigh cecal intubation rate (CIR) is associated with significant improved adenoma detection rate (ADR), however, self-reported CIR may be overestimated and inadequate documentation of cecal intubation is associated with a lower polyp detection rate compared to clear documentation. We aimed to investigate if ileal intubation may be associated with higher detection rates (DR) for right-sided conventional adenomas (cAD) and serrated polyps (SP) compared to cecal intubation in a large screening colonoscopy cohort.Material and methodsRetrospective analysis of individuals ≥50 years with average risk for colorectal cancer (CRC) who underwent screening colonoscopy between 01/01/2012 and 14/12/2016 at a tertiary academic hospital and six community-based private practices. Exclusion criteria were conditions with increased risk for CRC (e.g. inflammatory bowel disease, history of CRC, hereditary cancer syndromes), previous colonoscopy at the same institution, and incomplete procedures. Right-sided colon was defined as caecum and ascending colon.Results4.138 individuals were analysed (mean age 62 years, 52.1% female). DR for right-sided cADs and SPs were significantly higher after ileal compared to cecal intubation in univariate (12.5% vs. 6.8%, p < 0.001, and 6.3% vs. 3.3%, p < 0.001), but not in multivariate analysis (OR 1.025, 95%-CI 0.639–1.646, p = 0.918, and OR 0.937, 95%-CI 0.671–1.309, p = 0.704). DRs did not differ between ileal and cecal intubation for endoscopists with ADR ≥25 and < 25%, respectively. ADR ≥25% was significantly associated with ileal intubation (OR 21.862, 95%-CI 18.049–26.481, p < 0.001).ConclusionIleal intubation may not provide any benefit over cecal intubation concerning the detection of cADs and SPs in the right-sided colon.