Early detection of colon cancer through screening is critical for improving long-term survival outcomes; however, only 54 % of the United States (U.S.) population that is eligible to have a colon cancer screening receive one. Previous research found that people who participate in physical activity (PA) are less likely to get screened due perception of having low risk. However, health organizations have lowered the age to initiate screening as more cases are being reported among younger U.S. residents. This study aimed to examine the association between colon cancer screening and self-reported health status for individuals meeting aerobic PA guidelines among individuals aged 45-54. We conducted a cross-sectional analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. We included all participants between the ages of 45 and 54 who responded to the questionnaire regarding colonoscopy and sigmoidoscopy examinations, and the supplementary module that features PA and sedentary behaviors. Among 1118 respondents, 503 (45.5 %) reported having undergone colon cancer screening via colonoscopy or sigmoidoscopy, whereas 615 (54.5 %) had not. Screening prevalence differed by insurance status (p=0.002), with higher rates among insured individuals (483/1034; 47.2 %) compared with uninsured individuals (11/65; 19.2 %). Screening also varied by race/ethnicity (p=0.022); rates were highest among White respondents (353/732; 49.9 %) and lowest among Asian respondents (16/60; 27.3 %). Screening did not significantly differ by education, sex, overweight/obesity status, transportation access, place of residence, or PA status (all p>0.05). Among respondents meeting aerobic PA guidelines (n=1048), 489 (47.0 %) reported screening. Neither cardiovascular disease (CVD) risk (adjusted odds ratio [AOR]=1.22, 95 % confidence interval [CI]: 0.87-1.70) nor self-reported good health (AOR=0.89, 95 % CI: 0.52-1.51) was associated with screening. Among those meeting both aerobic and strength training guidelines (n=541), 255 (48.8 %) reported screening. In this group, reporting good or better health was associated with lower odds of screening (AOR=0.37, 95 % CI: 0.15-0.90), while CVD risk remained nonsignificant (AOR=1.33, 95 % CI: 0.80-2.23). Our analysis found no link between colon cancer screening and self-reported health status for those meeting aerobic guidelines, but those who met both aerobic and strength training guidelines were less likely to get screened. Uninsured individuals and Asian Americans also had lower screening rates. These findings highlight the need for targeted public health campaigns to address screening disparities, particularly among active individuals and underserved communities.

Black men experience disproportionate prostate cancer mortality compared with men of other races. As of 2018, major guidelines concur that all men make informed decisions about whether to be screened for prostate cancer after a discussion with their clinician. The objectives of this study were to determine the frequency at which clinicians document prostate cancer screening shared decision-making (SDM) conversations, to examine whether SDM documentation rates differ by race and other sociodemographic factors, and to evaluate whether SDM affects rates of prostate cancer screening. We conducted retrospective chart reviews of a random sample of men (N=600) aged 45 to 69 years seen within an academic family medicine practice in South Carolina in 2019-2020. We used χ2 analyses to compare documentation of a prostate cancer SDM conversation and prostate-specific antigen (PSA) testing by race, age, family history of cancer, family history of prostate cancer, colon cancer screening adherence, and insurance. Logistic regressions assessed the effect of SDM, race, age, and insurance status on the completion of screening PSAs. SDM conversations were documented for 7.3% of Black men and 5.3% of non-Black men (P=0.37). Screening PSAs were ordered in 39.7% of Black men and 36.0% of non-Black men (P=0.41). SDM conversations were positively associated with prostate cancer screening in all men (71.8% vs 35.6%, P<0.01) and Black men specifically (85.0% vs 35.7%, P<0.01). Our results indicate very low rates of prostate cancer SDM in Black and non-Black men. Men with documented SDM conversations were significantly more likely to receive prostate cancer screening. Study results suggest the need for increased SDM in all patients and the need for improved clinician documentation of SDM conversations to evaluate whether men receive the standard of care regarding prostate cancer screening.

The USA is a low-incidence country for gastric cancer and screening is not performed. The use of diagnostic endoscopy (EGD) is not well standardized. As a result, patients most commonly have advanced-stage disease at diagnosis. All patients with gastric cancer treated at a single center over the past 10 years were identified, and demographics, presenting symptoms, diagnostic evaluations, stage at diagnosis, and outcomes were analyzed. A total of 249 patients with gastroesophageal junction (GEJ) or gastric or GEJ adenocarcinoma were identified. The presence of gastrointestinal (GI)-related symptoms at diagnosis was associated with more advanced disease (p < 0.001), but 73% of stage I patients were symptomatic. The median self-reported duration of symptoms prior to first EGD was 2 months (range 0-35 months), but nearly 50% of patients with stage IV were diagnosed by cross-sectional imaging before performance of EGD. In addition, 182 patients (73%) were participating in colon cancer screening. The median overall survival (OS) of the entire cohort was 23.0 months (95% CI 14.4-31.6) and was not reached for stage I patients, 47 months (95% CI 24.3-69.7) for stage II, 23.0 months (95% CI 19.9-26.3) for stage III, and 11.0 months (95% CI 6.6-15.4) for stage IV (p < 0.001). Non-EGD method of original diagnosis was an independent predictor of poorer survival, regardless of stage (HR 1.46, 95% CI 1.03-2.09; p = 0.036). Diagnostic EGD is underutilized in symptomatic patients, particularly those with dyspepsia, while most patients were participating in colon cancer screening. Novel protocols to standardize the use of diagnostic EGD should be investigated in the USA.

Myopic medical harm: a man receives free colon cancer screening in Ghana.

Colorectal cancer screening rates in the US remain suboptimal, particularly among low-income and minoritized populations, despite the availability of effective, low-cost options such as the fecal immunochemical test (FIT). Scalable outreach strategies are needed to improve uptake and reduce staff burden in safety-net settings. To evaluate whether a behavioral economics-informed, automated text messaging strategy was associated with increased FIT completion compared with nurse-led telephone call outreach. This quality improvement randomized clinical trial was conducted from April 7 to June 24, 2025, at 8 Federally Qualified Health Centers (FQHCs) in Brooklyn, New York, within the Family Health Centers at NYU Langone. Participants included adults (aged ≥18 years) with a new FIT order who listed English, Spanish, or Chinese (Mandarin or Cantonese) as their preferred language and had not opted out of text messaging. Patients were randomized 1:1 to receive either 3 automated, 1-way text message reminders on days 2, 5, and 8 (intervention) or a single nurse-led telephone call reminder on day 8 (usual care). The primary outcome was FIT completion within 21 days of the test order, assessed from the electronic health record. Secondary outcomes included completion at 7 and 14 days. FIT completion at 7, 14, and 21 days was compared between groups using χ2 tests. Among 1275 eligible randomized participants, 649 were assigned to the text group (418 female participants [64.4%]; mean [SD] age, 56.4 [9.3] years) and 626 to the telephone group (398 female participants [63.6%]; mean [SD] age, 56.7 [9.6] years). FIT completion within 21 days was higher in the text group (382 of 649 participants [58.9%]) compared with the telephone group (312 of 626 participants [49.8%]) with an absolute difference of 9.0 percentage points (95% CI, 3.6-14.5 percentage points; P = .001). Post hoc analyses found no evidence of differential effectiveness by age, sex, race and ethnicity, or patient portal use. In this quality improvement randomized clinical trial, a behaviorally informed text messaging strategy was associated with significantly improved FIT completion compared with usual nurse-led telephone outreach. Automated messaging may offer a scalable, low-cost strategy to promote preventive care and reduce staff burden in underserved populations. ClinicalTrials.gov Identifier: NCT06632054.

Evaluating Quality, Guideline Accuracy, and Racial/Ethnic Representation of YouTube Videos on Colon Cancer Screening.

Using Large Language Models to Determine Reasons for Missed Colon Cancer Screening Follow-Up.

Recently, stool- and blood-based cancer screening kits have been approved in clinical practice as convenient and noninvasive methods for colon cancer screening. One such test in long-standing practice has included the fecal immunochemical test (FIT), wherein home-based testing has rendered it a convenient initial assay to complement screening colonoscopy, despite limitations in diagnostic performance. In a recent original study published in the journal by Nguyen and colleagues, the feasibility and performance of combining FIT with circulating tumor cell (CTC) enumeration for predicting colorectal neoplasia and the risk of developing colorectal cancer were described. In this commentary, we highlight the potential of this combination as a novel colorectal cancer screening technique. The introduction of CTC as a potential colorectal cancer screening assay is timely, given the emergence of liquid biopsies that hold promise in their ability to detect a multitude of cancer-specific signals, from the detection of minimal residual disease to the detection of molecular alterations for precision therapies in oncology. We place the importance of their results in the context of the evolving landscape of stool- and blood-based colorectal cancer screening tests involving multitarget fecal DNA and cell-free DNA assays. See related article by Nguyen et al., Cancer Epidemiol Biomarkers Prev 2026;35:79-87.

Current Treatment Options in Gastroenterology: Colon Cancer Screening and Surveillance Therapy in Older Adults

A message in an app from her doctor following a routine colon cancer screening inspired the author to conceive of the drawing "physician communication." The author created the drawing so she could digest the words the doctor said-cellular, polyp, early-stage. As the author thought about their medical visit more, it struck her how big the issue of physician communication is, and how it has been an enormous challenge in my life. So many words are shared, and so much meaning is lost in translation. For the author, the drawing captures the essence of her medical visit because it represents the physician's body of high-level long words that keep the patient from understanding their circumstances. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Most research among adults with autism spectrum disorder (ASD) has been conducted in a White, English-speaking, and commercially insured population. However, patterns of care may differ in a more diverse safety-net setting. To assess health care utilization and cancer screening among patients with diagnosed ASD or another similar neurodivergent diagnosis as compared with the general clinic population in a safety-net adult primary care population. Retrospective cohort PATIENTS: Adults ≥ 18 with at least one primary care visit between 1/1/2021 and 5/10/2024. ASD and neurodivergent diagnoses were identified using ICD-10 codes. Outpatient visit completion and no-show rates; emergency department (ED) use and hospitalization; odds of cervical, breast, and colon cancer screening. Among 69,344 patients, 381 had a neurodivergent diagnosis (135 ASD and 246 other neurodivergent diagnoses). Compared to the general population, the neurodivergent group was younger (mean age 37.5 vs. 46.2) and more often male (55.9% vs. 42.9%) and had a higher median Elixhauser comorbidity index (1.0 vs. 0). Both groups had similar proportions of those on Medicaid (46.2% vs. 40.5%) and racial and ethnic diversity (19.9% vs. 19.5% identifying as White). In adjusted analyses, patients with neurodivergence had higher rates of ED visits (IRR 1.72, 95% CI 1.62-1.84) and hospitalizations (IRR 2.04, 95% CI 1.84-2.28) and lower odds of cervical cancer screening (OR 0.44, 95% CI 0.31-0.64). No significant differences were observed in colon cancer screening though the qualifying population was small; mammogram completion was too low for multivariate analysis. In a diverse safety-net setting, adult patients with neurodivergence are less likely to receive cervical cancer screening and more likely to use the ED and be hospitalized than the general population. These disparities underscore the need for targeted interventions to improve care for socially complex patients with ASD and other neurodivergent diagnoses.

PurposeSelection of osteoporosis (OP) treatment is affected by patients’ disease severity and fracture risk, potentially confounding real-world comparative effectiveness and safety studies of antiresorptive medications. To inform the choice of valid treatment contrasts for subsequent real-world comparative studies, we assessed comparability of antiresorptive OP treatment groups using negative control outcomes (NCOs).Patients and MethodsWomen aged ≥55 years in Optum© Clinformatics® Data Mart from October 2010 through June 2019 who received denosumab, zoledronic acid (ZA), or oral bisphosphonates (BPs) were included. We estimated the 1-year cumulative risks for 12 NCOs by treatment group among treatment-naïve and treatment-experienced women using augmented inverse-probability of treatment and censoring weighted (AIPW) estimation. A Bayesian sensitivity analysis was conducted to aggregate estimates and associated variances into a form characterized by magnitude and probability.ResultsWomen in both treatment-naïve (n = 199,335) and treatment-experienced (n = 33,296) cohorts initiated treatment at a mean age of 71.8 years. Treatment-naïve women initiating denosumab had similar 1-year risks of most NCOs compared with initiators of ZA (maximum observed RD = 2.47% for colon cancer screening). However, significant risk differences were observed for seven NCOs when comparing ZA or denosumab with oral BPs. Among treatment-experienced women, all NCOs indicated similar risks when comparing denosumab to alendronate alone. Only one NCO (dementia: RD = 0.42%) was associated with treatment when comparing denosumab to oral BPs, and one (influenza vaccine: RD = 3.57%) was associated with treatment when comparing ZA to oral BPs. Results of the Bayesian analysis aligned with our qualitative interpretations.ConclusionComparative studies including denosumab or ZA versus oral BPs among treatment-experienced, commercially insured women aged ≥55 years in the United States are likely valid with respect to comparability of treatment groups. Our results do not support conducting observational studies examining these treatment contrasts in the overall treatment-naïve population. However, comparison of ZA and oral BPs among treatment-naïve women with a prior fracture may be undertaken with minimal expected residual bias.

Abstract Background FIT is widely used for CRC screenings. Most Canadian programs only use one FIT sample when determining the need for a colonoscopy. It is unclear if an analysis of both samples in a standard two-sample kit improves detection of CRC and advanced adenomas. Aims To determine the positive predictive value (PPV) of one versus two abnormal FIT in the detection of colorectal cancer and advanced adenomas. Methods Over a five year period from 2020 to 2025, 84,489 completed FIT kits were received by the Newfoundland and Labrador colon cancer screening program. A participant completed two FIT samples and if one FIT was positive ( &amp;gt; =100ng/ml) a colonoscopy was arranged. Data collected included demographics, colonoscopy, pathology, and quantitative FIT results. PPV of one versus two abnormal FITs was calculated. Results 10,237 patients (12.1%) were positive when the FIT was analyzed. 9,203 colonoscopies were completed and 249 (2.7%) colorectal cancers were detected. The number of advanced adenomas was 26.2% and overall Adenoma Detection Rate was 61.1%. Of the 249 cancers detected, 183 patients had both FIT samples positive while 66 patients had one FIT sample positive and one negative, 33 of 249 (13.3%) of all cancers would have been missed if only one FIT was analyzed. For 2415 participants with advanced adenomas 1194 had one FIT positive and 1219 had both positive. If only one FIT test was analyzed 597 advanced adenomas would have been missed. The positive predictive value (PPV) of one vs. two positive FITs for cancer was 2.4% vs 2.7% (p value &amp;lt; 0.01) and the PPV for advanced adenoma was 19.8% vs. 26.2% (p value &amp;lt; 0.01). When the first FIT was negative, the second positive FIT detected 33 additional cancers and an extra 592 advanced adenomas. Absolute FIT values were also higher for patients with two FIT positive compared to one FIT positive for both cancer (6449 vs. 5337) and advanced adenomas (2243 vs. 878). Conclusions PPV of two positive FITs is superior to one positive FIT for both colorectal cancer and advanced adenomas. There was an added value when participants completed a second FIT kit. Funding Agencies None

Abstract Background Colorectal cancer (CRC) is the second leading cause of death from cancer in men and third in women in Canada [1]. In 2009, the Nova Scotia (NS) Colon Cancer Prevention Program (CCPP) was the first colon cancer screening program in Canada to provide population-based CRC screening mailing Fecal Immunochemical Testing (FIT) to all residents of NS between ages 50-74 enrolled in the provincial Medical Services Insurance program. Aims In 2023, NS Health changed their FIT vendor to a new supplier (Polmedco OC-Auto Sensor Diana) and the positivity threshold was decreased from 100 ng/ml to 50 ng/ml, in line with British Columbia. The aim of this study is to evaluate the positive predictive value (PPV) of the new positive threshold compared to the previous. We hypothesize that the PPV at the lower threshold will decrease for detection of all neoplasms. Methods We evaluated the PPV of the new FIT threshold in detecting colorectal lesions in the NS population between September 1st, 2023 – February 28th, 2025. PPV was evaluated for two outcomes: PPV1 – any pre-cancerous or cancerous lesion (serrated, adenomatous or malignant) and PPV2 – advanced adenoma or malignancy. PPV1 &amp; PPV2 were compared across three FIT thresholds: 50 – 74 ng/ml, 75 – 99 ng/ml and 100+ ng/ml using chi-square analysis. Results Using the Cancer Care Application of Screening Platform and Event Relationship, 7,271 FIT-positive cases underwent colonoscopy. Males represented 58.9%, with the highest positivity rate in the 70–74 age group (16.1%). The PPV1 was 87.9% overall, highest in the 70–74 age group (90.3%). The overall PPV2 was 32.6%, highest in the 50–54 age group (33.7%). When comparing FIT threshold groups, the 100+ ng/mL group had a significantly higher PPV1 (88.2%) compared to the 50–74 ng/mL (85.1%) and 75–99 ng/mL (85.5%) groups (p &amp;lt; 0.05), while the lower thresholds did not differ significantly from each other. FIT threshold was significantly associated with PPV2 (p &amp;lt; 0.001), increasing consistently with higher thresholds (Table 1). Conclusions Overall, the PPV remains high at 87.9% despite decreasing the qualtified FIT positivity threshold. Interestingly, the PPV1 did not differ between the two lower threshold groups, raising questions about the optimal cut-off given the added colonoscopy burden at lower positivity thresholds. The significant association between FIT threshold and PPV2 emphasizes the importance of maintaining a balance between the FIT positive threshold and endoscopy burden. Ongoing economic analyses will assess whether the higher FIT positivity rate at the new threshold provides net benefit through cancer prevention and earlier cancer detection despite increased colonoscopy demand. 1. Canadian Cancer Society. (2024). Colorectal Cancer Statistics. https://cancer.ca/en/cancer-information/cancer-types/colorectal/statistics A160 Table 1 Funding Agencies None

42 Background: Early-onset colorectal cancer (EOCRC), defined as a diagnosis of colorectal cancer in a patient &lt;50 years old, has been steadily increasing in incidence in resource-rich nations. It tends to be diagnosed at advanced stages, reinforcing the importance of timely diagnosis. Objectives: To describe the barriers to timely diagnosis of early-onset colorectal cancer. Methods: We performed a systematic review according to PRISMA guidelines, searching MEDLINE and Embase. Screening was done by two reviewers. Studies on experiences of patients with EOCRC and/or their caregivers or physicians were included. Case reports and literature reviews were excluded. A qualitative/thematic analysis was performed. Results: 14 studies with 4439 participants from the USA, Canada, Oceania, and Europe were selected for thematic analysis; they consisted of 6 surveys, 5 interviews, and 3 thematic analyses of internet forum posts. Patients and caregivers named misdiagnoses (11 studies), dismissive attitudes from physicians (8 studies), and lack of patient awareness of red flag symptoms (8 studies) as major factors delaying EOCRC diagnosis. The most common misdiagnosis was hemorrhoids (6 studies). Younger age (9 studies), female sex (3 studies) and non-specific symptoms (1 study) contributed to dismissal of patient concerns. None of the studies discussed lack of access to primary care as a factor. Patients reported having to self-advocate (6 studies) and see multiple physicians (5 studies) before their diagnosis with EOCRC. Conclusions: Given the rising incidence of advanced-stage EOCRC, it is imperative that physicians seriously consider possible malignancy in symptomatic patients &lt;50 years old to allow timely diagnosis and treatment. Increased awareness of EOCRC has led to a lowered colon cancer screening age starting at 45 years old by The US Preventive Services Task Force. However, the starting age for colon cancer screening in Canada remains at 50 years old.

IntroductionTherapeutic intervention with chemopreventive agents (CPA) represents a promising avenue for cancer prevention; however, additional data on patient adherence are needed. We developed the Colorectal Cancer Chemoprevention Acceleration Platform (CRC-CHAMP) and examined the feasibility of real-world CPA intervention in persons with an increased risk for CRC. Herein, we describe the recruitment, uptake, and adherence within this pilot study.MethodsFor this single-arm prospective pilot study (NCT05402124), we recruited individuals from the Forzani and MacPhail Colon Cancer Screening Centre (CCSC) in Calgary, Alberta, Canada. Eligible individuals were between the ages of 50-59 and had a history of high-risk adenomatous polyps diagnosed at the CCSC in the preceding 12 months. After consenting, each participant was provided open-label acetylsalicylic acid (ASA) at 81 mg every day for 90 days. Participants were contacted by telephone every 30 days to collect current adherence (primary outcome) and occurrence of any adverse events (secondary outcome).ResultsThroughout recruitment, 823 potential participants were identified, with 69 (53.1%) being eligible and 67 (51.5%) finally enrolling in the study. The median age of the participants was 56 yr. At the follow-ups, 60 participants (89.6%) were adherent at 30 days, 54 participants (80.6%) were adherent at 60 days, and 55 (82.1%) participants were adherent at 90 days. A total of 9 (13.4%) participants experienced minor adverse events likely unrelated to the ASA.ConclusionParticipants recruited to this pilot study had a high level of adherence throughout the 90-day period with minimal side effects. Challenges to recruitment included low response rate by mail and a high number of those contacted already taking non-steroidal anti-inflammatory drugs. This study suggests that individuals post-polypectomy of large polyp may be interested in CRC chemoprevention. Additionally, this study provides a framework for future evaluation of additional therapeutic interventions.

ABSTRACT Background Colorectal cancer (CRC) is a leading cause of global cancer-related mortality and morbidity, with rising incidence in Sub-Saharan African countries over the past decade. This study aims to determine the prevalence, and describe location, as well as histopathology of polyps in patients undergoing colonoscopy in Ghana. The prevalence and polyp characteristics provide additional data and have implications for developing locally relevant screening guidelines. Research design and methods Retrospective chart review of patients ≥18 years who completed a colonoscopy at the anonymized from 1 January 2021 to 31 December 2023. Results 510 patients were included in the analysis. The mean age was 54.8 (±0.7 SD); 62% were males. Abnormal findings included hemorrhoids (47.1%), polyps (30.0%), diverticular disease (10.2%), and colonic mass (2.4%). Overall adenoma detection rate (ADR) was 26.1%. Histopathology showed 30.8% tubular adenoma, 30.1% hyperplastic polyps, and 16.0% tubulovillous adenoma. The highest burden of polyps was in the 60- to 80-year-old age group. The prevalence of CRC was 2.2% in our study. Conclusions CRC prevalence rates remain relatively low in Sub-Saharan Africa. Access to screening is limited, and the numbers may be underestimated. A cost-effective screening strategy to improve early detection and outcomes is needed.

Background: Cancer is a leading cause of death among unhoused people, and the limited prior studies on colorectal cancer (CRC) screening in this group have shown low rates of screening compared to the general population.Methods: Physicians administered surveys to patients at the University of California, Los Angeles Mobile Clinic who were experiencing homelessness or housing insecurity to determine rates of prior CRC screening, establish a baseline understanding of CRC screening, and elucidate barriers to screening. Physicians also administered a brief educational intervention about CRC screening and then administered a post-intervention survey to assess changes in participants’ understanding and preferences related to CRC screening. Results: A total of 44 patients completed both the pre- and post-surveys and the educational intervention. Fewer than 50% of respondents aged 45 or older had a primary care provider (PCP) (n = 21) or had undergone CRC screening (n = 13). Patients who had health insurance - and particularly those who had a PCP - were more likely to have been offered and to have completed screening. CRC screening knowledge and self-efficacy increased after the brief educational intervention.Conclusion: Helping unhoused patients obtain health insurance and establish care with a PCP may create opportunities to discuss preventive care and improve CRC screening rates.

The fecal immunochemical test (FIT) is indicated for colon cancer screening in asymptomatic average-risk patients. However, the inclusion of orders for non-indication-based FITs in medical records has led to increased inappropriate use in emergency department (ED) and inpatient settings. This study aimed to evaluate the clinical impact of FIT results when the test is used for purposes other than routine screening. We conducted a single-center, retrospective chart review using electronic medical records, analyzing patients who underwent the FIT in the ED or while admitted to the VA Hospital from September 2013 through December 2016. The collected data included demographics; clinical symptoms and signs; medications; and information on digital rectal examinations, gastroenterology consultations, and endoscopic procedures. Of the 1,354 patients included, most were men. Among FIT-positive patients, the mean age was 73.7 years. The majority of FITs were done in the ED. Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea. Anticoagulants were associated with positive FIT results. Patients with positive tests often received gastroenterology consultations and were more likely to undergo endoscopic procedures. None of the evaluated FITs were used for screening, confirming that they had been ordered inappropriately. This indiscriminate use can lead to unnecessary interventions and prolonged hospitalizations. Additionally, negative tests may lead to underestimate worrisome symptoms or features that require further investigation. In conclusion, our study does not support the indiscriminate use of the FIT in inpatient or ED settings.

Age-appropriate colon cancer screening is recommended for cardiac transplant evaluation. Patients with advanced cardiomyopathy may require inpatient evaluation and inotropes or mechanical circulatory support (MCS) for optimization. The peri- and postprocedural risks of colonoscopy amongst this population are not well defined. We hypothesized that patients requiring hemodynamic support during colonoscopy are at an increased risk for complications. We retrospectively analyzed adult patients at our center from 2018-2023 who underwent inpatient colonoscopy as part of a cardiac transplant evaluation. The primary outcome was any adverse event, including increased oxygen requirement (escalation to higher form of oxygen delivery), major (≥ 3 g/dL) or minor (&lt;3 g/dL) bleeding, new arrhythmia or new hypotension requiring vasopressors for up to 48 hours post-procedure. We performed descriptive and multivariable regression analyses. Fifty-nine patients (mean age 59 years, 46 (78%) male) with advanced cardiomyopathy underwent inpatient colonoscopy for cardiac transplant evaluation. At the time of colonoscopy, 38 patients required hemodynamic support, 29 (49.2%) with inotrope infusions, 7 (11.9%) with MCS, and 2 (3.4%) with both. Thirty-nine (66.1%) were on systemic anticoagulation prior to colonoscopy, with 9 (15.3%) continuing periprocedurally. Patients on hemodynamic support had a lower baseline left ventricular ejection fraction. Baseline characteristics were otherwise well balanced between the two groups (Table 1). Following colonoscopy, adverse events occurred in 7 (11.9%) patients, including increased oxygen requirement in 1 (1.7%), minor bleeding in 4 (6.8%), and new arrhythmia in 2 (3.4%). There were no major bleeding events or postprocedural hypotension in any patients. MCS or inotrope use was not associated with adverse events (p=0.993), even after controlling for age, BMI, gender, baseline oxygen requirement, diabetes and anticoagulation (p=0.996). Malignancy was not found in any patient. In a single-center analysis of hospitalized adults undergoing a cardiac transplant evaluation, we found an 11.9% rate of adverse events driven by minor bleeding. There was no association between hemodynamic support with inotropes or MCS during colonoscopy and adverse events.