Colorectal Cancer Screening Rates Research Articles

A pragmatic randomized trial of mailed fecal immunochemical testing to increase colorectal cancer screening among low-income and minoritized populations.

Colorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity. A hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant. Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals). A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

Evaluation of population-based screening programs on colorectal cancer screening uptake and predictors in Atlantic Canada: insights from a repeated cross-sectional study

BackgroundColorectal cancer (CRC) poses a significant public health challenge in Canada, with the Atlantic provinces bearing a particularly high burden. The implementation of population-based colon screening programs is aimed to address this concern. However, limited research exists on the effect of these programs especially in Canada. This study aimed to examine the impact of the first few years of the CRC screening programs in the Atlantic provinces of Canada by assessing changes in screening uptake, barriers, and predictors of screening among eligible populations.MethodsEmploying a repeated cross-sectional design, this study analyzed data from a representative sample of 7614 respondents in 2010 and 6850 in 2017 from the Atlantic provinces aged 50–74 years, extracted from the Canadian Community Health Survey (CCHS). The outcomes measured were CRC screening rates, changes in predictors of screening uptake, and barriers to participation. Potential predictors examined included age, sex, income, education, smoking, and health status.ResultsThe proportion of adults aged 50–74 years who meet CRC screening requirements increased from 42% in 2010 to 54% in 2017 yet below the national target of 60%. New Brunswick reported the most significant increase in screening prevalence (18%, p < 0.05). Participation in fecal tests increased from 19.6 to 32.4%. Despite these improvements, disparities in screening participation remained, with lower uptake observed among individuals with lower income and education levels. Age (> 60 years, OR = 2.09, p < 0.01), the presence of multiple chronic health conditions (OR = 2.11, p < 0. 01), being female (OR = 1.21, p < 0.01), married status (OR = 1.21, p < 0.05), access to regular healthcare (OR = 1.91, p < 0.01), and nonsmoking status (OR = 2.55, p < 0.01) were identified as significant predictors of CRC screening uptake.ConclusionsThis study shows that while CRC screening uptake increased across the Atlantic provinces between 2010 and 2017, barriers to and disparities in screening participation persist. This highlights the need for targeted interventions to improve awareness, access, and screening uptake, particularly among disadvantaged groups, to promote equitable healthcare outcomes. Continued efforts should focus on reducing barriers to screening and leveraging available evidence to inform interventions aimed at mitigating the CRC burden in the region.

Barriers and facilitators of implementing a multicomponent intervention to improve faecal immunochemical test (FIT) colorectal cancer screening in primary care clinics, Alberta

Background and objectiveColorectal cancer (CRC) screening is effective at reducing the incidence and mortality of CRC. To address suboptimal CRC screening rates, a faecal immunochemical test (FIT) multicomponent intervention was...

Impact of Primary Care Providers and Health Insurance Type on Colorectal Cancer Screening in the United States.

Colorectal cancer (CRC) is a major cause of cancer deaths. We evaluated the effect of health insurance type and primary care provider (PCP) access on CRC screening. HINTS data were used to analyze CRC screening. Individuals aged 50 to 65 years had comparable screening rates across all insurance types. Beyond 65 years, individuals with Medicare or Medicare with private insurance were more likely to undergo screening than private insurance users. PCP access increased CRC screening rates. Among PCP users, Medicare, income, and smoking status influenced screening. Medicare and PCP access influence CRC screening. All individuals should be linked with PCPs.

Association between the social vulnerability index and breast, cervical, and colorectal cancer screening rates in Rhode Island.

Cancer screening is effective in reducing the burden of breast, cervical, and colorectal cancers, but not all communities have appropriate access to these services. In this study, we aimed to identify under-resourced communities by assessing the association between the Social Vulnerability Index (SVI) with screening rates for breast, cervical, and colorectal cancers in ZIP-code tabulation areas (ZCTAs) in Rhode Island. This study leveraged deidentified health insurance claims data from HealthFacts RI, the state's all-payer claims database, to calculate screening rates for breast, cervical, and colorectal cancers using Healthcare Effectiveness Data and Information Set measures. We used spatial autoregressive Tobit models to assess the association between the SVI, its four domains, and its 15 component variables with screening rates in 2019, accounting for spatial dependencies. In 2019, 73.2, 65.0, and 66.1% of eligible individuals were screened for breast, cervical, and colorectal cancer, respectively. For every 1-unit increase in the SVI, screening rates for breast and colorectal cancer were lower by 0.07% (95% CI 0.01-0.08%) and 0.08% (95% CI 0.02-0.15%), respectively. With higher scores on the SVI's socioeconomic domain, screening rates for all three types of cancers were lower. The SVI, especially its socioeconomic domain, is a useful tool for identifying areas that are under-served by current efforts to expand access to screening for breast, cervical, and colorectal cancer. These areas should be prioritized for new place-based partnerships that address barriers to screening at the individual and community level.

Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program.

Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured. We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population. The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted. In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction. This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.

Trends in colorectal cancer screening from the National Health Interview Survey (NHIS): analysis of the impact of different modalities on overall screening rates.

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in adults in the United States. Despite compelling evidence of improved outcomes in CRC, screening rates are not optimal. This study aimed to characterize CRC screening trends over the last two decades and assess the impact of various screening modalities on overall CRC screening rates. Using National Health Interview Survey data from 2005-2021, we examined CRC screening (colonoscopy, mt-sDNA, FOBT/FIT, sigmoidoscopy, CT Colonography) rates among adults aged 50-75 years (n = 85,571). A pseudo-time-series cross-sectional (pseudo-TSCS) analysis was conducted including a random effects GLS regression model to estimate the relative impact of each modality on changes in CRC screening rates. Among 50-75-year-olds, the estimated CRC screening rate increased from 47.7% in 2005 to 69.9% in 2021, with the largest increase between 2005 and 2010 (47.7% to 60.7%). Rates subsequently plateaued until 2015 but increased from 63.5% in 2015 to 69.9% in 2018. This was primarily driven by the increased use of mt-sDNA (2.5% in 2018 to 6.6% in 2021). Pseudo-TSCS analysis results showed that mt-sDNA contributed substantially to the increase in overall screening rates (77.3%; p < 0.0001) between 2018-2021. While CRC screening rates increased from 2005 to 2021, they remain below the 80% goal. The introduction of mt-sDNA, a non-invasive screening test may have improved overall rates. Sustained efforts are required to further increase screening rates to improve patient outcomes and offering a range of screening options is likely to contribute to achieving this goal.

The impact of the affordable care act and Medicaid expansion on colorectal cancer screening: Evidence from the 5th year of Medicaid expansion.

Colorectal cancer screening rates remain suboptimal, particularly among low-income populations. Our objective was to evaluate the long-term effects of Medicaid expansion on colorectal cancer screening. This cross-sectional study analyzed data from 354,384 individuals aged 50-64 with an income below 400% of the federal poverty level (FPL), who participated in the Behavioral Risk Factors Surveillance System from 2010 to 2018. A difference-in-difference analysis was employed to estimate the effect of Medicaid expansion on colorectal cancer screening. Subgroup analyses were conducted for individuals with income up to 138% of the FPL and those with income between 139% and 400% of the FPL. The effect of Medicaid expansion on colorectal cancer screening was examined during the early, mid, and late expansion periods. The primary outcome was the likelihood of receiving colorectal cancer screening for low-income adults aged 50-64. Medicaid expansion was associated with a significant 1.7 percentage point increase in colorectal cancer screening rates among adults aged 50-64 with income below 400% of the FPL (p < 0.05). A significant 2.9 percentage point increase in colorectal cancer screening was observed for those with income up to 138% the FPL (p < 0.05), while a 1.5 percentage point increase occurred for individuals with income between 139% and 400% of the FPL. The impact of Medicaid expansion on colorectal cancer screening varied based on income levels and displayed a time lag for newly eligible beneficiaries. Medicaid expansion was found to be associated with increased colorectal cancer screening rates among low-income individuals aged 50-64. The observed variations in impact based on income levels and the time lag for newly eligible beneficiaries receiving colorectal cancer screening highlight the need for further research and precision public health strategies to maximize the benefits of Medicaid expansion on colorectal cancer screening rates.

106 Transforming Health Equity with an Innovative Social Determinants of Health Platform: Application of HOUSES Index to Colorectal Cancer Screening

OBJECTIVES/GOALS: To tackle population-level health disparities, quality dashboards can leverage individual socioeconomic status (SES) measures, which are not always readily accessible. This study aimed to assess the feasibility of a population health management strategy for colorectal cancer (CRC) screening rates using the HOUSES index and heatmap analysis. METHODS/STUDY POPULATION: We applied the 2019 Minnesota Community Measurement data for optimal CRC screening to eligible Mayo Clinic Midwest panel patients. SES was defined by HOUSES index, a validated SES measure based on publicly available property data for the U.S. population. We first assessed the association of suboptimal CRC screening rate with HOUSES index adjusting for age, sex, race/ethnicity, comorbidity, and Zip-code level deprivation by using a mixed effects logistic regression model. We then assessed changes in ranking for performance of individual clinics (i.e., % of patients with optimal CRC screening rate) before and after adjusting for HOUSES index. Geographical hotspots of high proportions of low SES AND high proportions of suboptimal CRC screening were superimposed to identify target population for outreach. RESULTS/ANTICIPATED RESULTS: A total of 58,382 adults from 41 clinics were eligible for CRC screening assessment in 2019 (53% Female). Patients with lower SES defined by HOUSES quartile 1-3 have significantly lower CRC screening compared to those with highest SES (HOUSES quartile 4) (adj. OR [95% CI]: 0.52 [0.50-0.56] for Q1, 0.66 [0.62-0.70] for Q2, and 0.81 [0.76-0.85]) for Q3). Ranking of 26 out of 41 (63%) clinics went down after adjusting for HOUSES index suggesting disproportionately higher proportion of underserved patients with suboptimal CRC screening. We were able to successfully identify hotspots of suboptimal CRC (area with greater than 130% of expected value) and overlay with higher proportion of underserved population (HOUSES Q1), which can be used for data-driven targeted interventions such as mobile health clinics. DISCUSSION/SIGNIFICANCE: HOUSES index and associated heatmap analysis can contribute to advancing health equity. This approach can aid health care organizations in meeting the newly established standards by The Joint Commission, which have elevated health equity to a national safety priority.

Barriers and facilitators to implementing a multilevel, multicomponent intervention promoting colorectal cancer screening in health centers: a qualitative study of key informant perspectives

BackgroundColorectal cancer (CRC) continues to be a major cause of death in the U.S. despite the availability of effective screening tools. U.S. Latinos have lower rates of CRC screening and higher rates of death due to colorectal disease compared to non-Hispanic whites. Federally Qualified Health Centers (FQHCs) serve medically underserved populations, including many Latino patients. Given the low CRC screening rates, identifying culturally sensitive and cost-effective methods of promoting screening is a priority for many FQHCs.MethodsWe interviewed FQHC leaders and providers using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementation of a multilevel, multicomponent (ML-MC) CRC screening intervention (i.e., promotor navigation and group-based education) in FQHCs. A rapid qualitative analysis approach was used to identify themes organized according to the following CFIR constructs: intervention characteristics, outer and inner settings, and characteristics of the individual.ResultsWe completed interviews with 13 healthcare professionals in leadership positions at six FQHCs. The participating FQHCs perceived the ML-MC screening CRC program as feasible and expressed interest in implementing the program at their sites. Facilitators included financial incentives for increasing screening rates, the need for patient education programming, and involving promotores to support the work of clinical teams. Barriers included concerns about available resources to implement new programs, lack of federal reimbursement for health education, competing priorities of other health concerns, and the need for more resources for confirmatory screening and treatment following a positive screen.ConclusionsFQHCs provide essential primary care to millions of underserved patients in the U.S. and have the ability and motivation to provide screenings for colorectal cancer. Partnering with an academic institution to deliver a group-based, promotor-led CRC screening intervention for patients not up to date with screening could help increase screening rates. By identifying the specific barriers and facilitators to implementing CRC intervention, findings suggest that group-based, promotor-led interventions are a promising approach.

Colorectal Cancer Screening Rates at Federally Qualified Health Centers From 2014 to 2022: Incomplete Recovery From COVID-19 and Worsening Disparities.

Federally Qualified Health Centers (FQHC) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. Overall CRC screening participation in the United States declined during the COVID-19 pandemic and recovered by 2021; however, trends in underresourced settings are unknown. Using Uniform Data System data from 2014 to 2022, we assessed trends in FQHC CRC screening rates nationally, in California, and in Los Angeles County and determined clinic-level factors associated with recent screening rate changes. For each FQHC, we calculated the screening rate change from 2019 to 2020, 2020 to 2021, and 2020 to 2022. We used mixed-effects linear regression to determine clinic-level characteristics associated with each screening rate change. Across all FQHC (n = 1,281), 7,016,181 patients were eligible for CRC screening in 2022. Across the United States and in California, median screening rates increased from 2014 to 2019, severely declined in 2020, and failed to return to prepandemic levels by 2022. Both nationally and in California, CRC screening declined most dramatically from 2019 to 2020 in FQHC serving majority Hispanic/Latino patients or a high proportion of patients experiencing homelessness. From 2020 to 2022, screening rates did not recover completely in US FQHC, with disproportionate recovery among FQHC serving majority non-Hispanic Black patients. CRC screening rates at FQHC did not return to prepandemic levels by 2022, and recovery varied by FQHC patient characteristics. Tailored interventions addressing low and decreasing CRC screening rates in FQHC are urgently needed to mitigate worsening CRC disparities.

Abstract 4786: Colorectal cancer screening rates among deaf, deafblind, and hard of hearing adults aged 45 to 75 years old

Abstract Background: Deaf, deafblind, and hard of hearing (DDBHH) individuals who use American Sign Language (ASL), a subpopulation of the disability, experience disparities concerning cancer screening and cancer-related health outcomes. For this study, we explored colorectal cancer screening rates among DDBHH survey respondents in comparison to rates found in the hearing population. Materials and Methods: Using the National Cancer Institute Health Information National Trends Survey in ASL (Kushalnagar et al., 2015), we surveyed participants 18+ years old using the Center for Deaf Health Equity at Gallaudet University’s database of over 2,500 DDBHH participants from all over the USA, including Hawaii and Puerto Rico. We used the U.S. Preventive Services Task Force (USPSTF) guidelines’ age cutoffs to assess adherence to colorectal cancer screenings. Results: Survey response rate within three weeks of mail out in July 2023 was 12%. A total of 405 DDBHH adult participants answered screening questions for colorectal cancer in ASL and English. Overall, 43.7% self-reported screening adherence for age-eligible (45-75 years) colorectal cancer screening; 54.7% reported never having a colorectal cancer screening. Similarly-aged hearing adults reported 58.7% adherence in the English version of the National Health Interview Survey (NHIS). Discussion: With the 43.7% adherence rate, the DDBHH community is lagging behind colorectal cancer screenings compared to the general population of hearing adults. Estimating the colorectal cancer screening rates among the DBHH community and understanding the reasons for these existing disparities is important to achieve screening adherence of 68.3%, the target set by the Healthy People 2030. Such research will aid the Center for Deaf Health Equity to actively work with the community to improve strategies to increase colorectal cancer screening. Citation Format: Regina M. Wang, Sowmya R. Rao, Erika J. Bergeron, Emmanuel C. Perrodin-Njoku, Poorna Kushalnagar. Colorectal cancer screening rates among deaf, deafblind, and hard of hearing adults aged 45 to 75 years old [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4786.

Abstract 1298: Assessing the impact of Medicaid expansion on colorectal cancer preventative services utilization

Abstract Introduction: Colorectal cancer (CRC) is the second leading cause of cancer mortality. CRC screening rates have steadily risen and incidence rates around the nation have declined. To date, forty-one states have expanded Medicaid across the United States, with 9 states remaining that have not expanded. Although, access through insurance has increased, colorectal disparities in screening and mortality persist. Other studies have shown that screening guideline concordance can be inconsistent based on insurance type. Data suggests Medicaid enrollees are more likely to present advanced-stage cancers than those privately enrolled. The screening differences throughout the United States emphasize how complex colorectal cancer disparities are and how insurance may play a role. Aims: Our study aims to investigate the impact of Medicaid expansion on timely CRC screenings, specifically examining whether these effects differ by African Americans, Hispanics, and White Americans. Methods: Data was utilized from the Behavioral Risk Factor Surveillance System (BRFSS) to analyze timely CRC screening data of adults below 138% of the federal poverty level (FPL) of states with different Medicaid expansion statuses. Most recently available data was used in our analysis spanning the years 2014-2022 in all 50 states. States were stratified by dummy variables for Medicaid expansion and non-expansion status. Timely CRC screenings were determined by eligible respondent responses. Difference-in-difference analyses were used to study the effect of Medicaid expansion on timely CRC screenings in states with different Medicaid expansion statuses. Results: Our sample included 60.52% White Americans, 12.22% African Americans, and 16.41% Hispanics in both Medicaid expanded and non-expanded states. Sex and race had significant associations to Medicaid expansion status and timely CRC screenings, particularly when analyzing race for Hispanics and White Americans. Between 2014 and 2022, timely CRC screening for low-income adults in Medicaid expansion states was at 33.15% compared to 23.17% from non-expansion status states. Notably, adults aged 45-64 demonstrated the highest differences in timely CRC screenings for Medicaid-expanded states (12.26% and 18.98%) compared to non-expanded states (9.27% and 13.96%, respectively). Citation Format: Paulette Omeaku. Assessing the impact of Medicaid expansion on colorectal cancer preventative services utilization [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1298.

Abstract 4787: Preference for multi-target stool DNA for colorectal cancer screening among Alaska Native people in rural/remote communities

Abstract Background: The Alaska Tribal Health System is working on increasing colorectal cancer (CRC) screening rates among Alaska Native people, who have the highest CRC rates in the world. Most remote Alaska Native communities are not connected to the road system, which severely limits access to screening colonoscopy. As part of a clinical trial, Alaska Native patients were offered either colonoscopy or the at-home multi-target stool DNA test (mt-sDNA; Cologuard®). Patients had never been offered mt-sDNA before and it was unknown what they would think about the new test option. Both tests were provided at no cost to patients. Methods: From April 2022 to July 2023, 194 patients who chose mt-sDNA for screening received a follow-up phone survey asking whether they were aware that they could have had colonoscopy instead, their reasons for choosing mt-sDNA, and the factors influencing their choice of mt-sDNA over colonoscopy. Patients answered the survey before receiving results of their mt-sDNA test in order to capture initial screening test preferences. Results: A total of 115 (59%) Alaska Native patients participated in the survey; 56% men and 44% women. About 70% were ages 45 to 60 years while the remaining 30% were 61 to 75 years old. The majority (80%) were aware that they had the option to undergo colonoscopy for CRC screening instead of mt-sDNA. Key themes for mt-sDNA preference included not having to travel, less time commitment, and greater convenience. Many patients expressed financial concerns arising from the costs of air travel and accommodation required to access screening colonoscopy even though the procedure itself was covered. Additionally, patients highlighted existing obligations such as childcare and work responsibilities which made the use of mt-sDNA at home more appealing. Many respondents also shared negative perceptions of colonoscopy procedure including fear, embarrassment, and discomfort as reasons why they preferred mt-sDNA instead. Conclusions: These findings demonstrate the multifaceted factors influencing the preference for at-home mt-sDNA CRC screening among Alaska Native individuals. Challenges such as limited access to medical facilities, financial burdens, and personal commitments have significant bearing on the screening decision-making process. Moreover, the emotional aspect of fear and discomfort associated with colonoscopy plays a role in shaping these preferences. CRC screening programs need to be aware of patient needs and preferences when deciding which screening methods to offer to increase screening rates and result in improved colorectal health outcomes. Citation Format: Diana Redwood. Preference for multi-target stool DNA for colorectal cancer screening among Alaska Native people in rural/remote communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4787.

A Qualitative Study Exploring Barriers to Colorectal Cancer Screening among Firefighters.

Firefighters are at increased risk of colorectal cancer (CRC), yet rates of CRC screening are low among this occupational group. This study examines perceived risks, barriers, and facilitators to CRC screening. Three semi-structured focus group discussions were conducted by investigators in Tucson, AZ. Thematic analysis was used to identify patterns and themes in the data. Three groups of firefighters (8 male (57%); 6 female (43%) mean age 50.4 (SD = 12.2) years) voluntarily participated in the CRC discussions. Four major themes were examined: (1) perceptions of risk for CRC, (2) barriers to cancer screening, (3) facilitators to getting cancer screening, and (4) misinformation about CRC and screening. Findings indicate unique perceptions, attitudes, and beliefs among firefighters. Results from this study will inform the adaptation of a tailored CRC screening intervention for firefighters.

Low Rates of Colorectal Cancer Screening in Our Patients' First-Degree Relatives: Are We Failing Them?

Guidelines recommend screening those with a family history of early-onset colorectal cancer at age 40 or 10 years before the age of their relative's diagnosis. Currently, there is no literature reporting the screening rate in these individuals and no protocols are in place to identify and target this population for screening awareness. Assess adherence to current screening guidelines among FDRs of patients with early-onset colorectal cancer. Retrospective and qualitative study involving a telephone survey where patients were asked about relative's screening status and barriers to screening. Two community-based institutions between January 2018-December 2021. Individuals diagnosed with early-onset colorectal cancer who had undergone surgery at our institutions. Rate of screening in first-degree relatives of our patients with early-onset colorectal cancer. Other factors measured included demographics, clinicopathologic characteristics and screening barriers. Thirty-six patients were identified. Survey response rate was 66.6% (n=24). A total of 88 first-degree relatives who met criteria for screening resulted, with 67.1% (n=59) having a known screening status. Of the 59 with known screening status, it was reported that only 44% (n=26) have undergone screening. Patients of African American race, stage III/IV disease, Medicare/Medicaid and living within Baltimore City County were more likely to have family members with unknown or no screening. Lack of insurance coverage was the most common barrier noted 12.5% (n=3); whereas 54.1% (n=13) reported no barriers to screening. Retrospective design. Most first-degree relatives of patients diagnosed with early-onset colorectal cancer do not undergo colorectal cancer screening. This could be attributed to the lack of protocols that could guarantee these individuals are informed of their elevated risk and the different options available for screening. Furthermore, our study suggests that racial and socioeconomic disparities exist among high-risk patients who should pursue screening. See Video Abstract.

Social Determinants of Health and the Link to Colorectal Cancer Outcomes.

OPINION STATEMENT: Colorectal cancer (CRC) remains the second most deadly cancer in the United States, behind only lung cancer. Despite improvements in incidence due to screening and mortality in part due to better treatments, there are some groups that have not seen these promising changes. American Indian/Alaska Native and non-Hispanic Black individuals, certain geographic regions, and lower socioeconomic groups have all been shown to have worse CRC outcomes. A significant body of evidence has linked these disparities in outcomes to social determinants of health (SDH). SDH are defined by the WHO as "the non-medical factors that influence health outcomes." These factors include but are not limited to income, education, social support, neighborhood of residence, and access to healthcare. Individuals who are negatively impacted by SDH have been shown to have a higher incidence of CRC. These individuals are also less likely to receive adequate CRC screening, are less likely to receive appropriate treatment, and have increased CRC mortality. Interventions that target different SDH domains have been shown to lead to increased rates of CRC screening and receipt of appropriate treatment while simultaneously improving CRC mortality. The aim of this review is to highlight the connection between SDH and CRC outcomes while also exploring interventions that target SDH and thereby improve CRC outcomes.

Evaluation of Colorectal Cancer Screening Awareness and Compliance Rates over the Age of 40: Single Center Data in Türkiye

The frequency of colorectal cancer is increasing under the age of 50, and new sights have emerged regarding the initiation of screening in the earlier age group. This study aims to measure the consciousness of patients over the age of 40 about colorectal cancer screening and to reveal the screening rates of individuals over the age of 50. 300 consecutive patients who applied to our center and were older than 40 years of age were included. The questionnaire was created based on current guidelines and literature knowledge by the investigators and done through face-to-face interviews. Patients over 50 years of age who did not undergo screening were analyzed by dividing them into groups according to their socio-demographic characteristics and colorectal cancer risk factors. While 64.7% of the participants stated that they knew about colorectal cancer screening, only 32.4% of the participants aged 50 and over had colorectal cancer screening. The vast majority of patients stated that they did not have enough knowledge about the subject. The rate of participants who stated that they were considering entering the cancer screening program after completing this questionnaire was 73.7%. Colorectal cancer screening rates of non-smokers, women, and married participants were higher than the other group (P=0.016, P=0.017, and P=0.033, respectively). This study shows low screening compliance of individuals over the age of 50. We think that it is important to encourage and inform all adults over the age of 40 about colorectal cancer screening for public health.

Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States.

Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.

Uptake and detection rate of colorectal cancer screening with colonoscopy in China: A population-based, prospective cohort study

BackgroundColorectal cancer is the leading cause of cancer-related death worldwide. Colonoscopy is widely used as a screening test for detecting colorectal cancer in many countries. However, there is little evidence regarding the uptake and diagnostic yields of colonoscopy in population-based screening programs in countries with limited medical resources. ObjectiveWe reported the uptake of colonoscopy and the detection of colorectal lesions and explored related factors based on a colorectal cancer screening program in China. DesignIndividuals aged 45–74 years who were asymptomatic for colorectal cancer and had no history of colorectal cancer were recruited. An established risk score system was used to identify individuals at high risk for colorectal cancer, and they were subsequently recommended for colonoscopy. SettingA population-based, prospective cohort study was implemented in 169 communities, 14 districts of Chongqing, Southwest China. ParticipantsA total of 288,150 eligible participants were recruited from November 2013 to June 2021, and 41,315 participants were identified to be at high risk of colorectal cancer. MethodsGeneralized linear mixed model was used to explore the individual and community structural characteristics associated with uptake of colonoscopy. Additionally, the detection rate of colorectal lesions under colonoscopy screening was also reported, and their associated factors were explored. Results7859 subjects underwent colonoscopy, with an uptake rate of 19.02 % (95 % CI 18.64 %–19.40 %). Lower uptake rates were associated with older age, lower education, more physical activity, and structural characteristics, including residing in developing areas (OR 0.73, 95 % CI 0.69–0.78), residing more than 5 km from screening hospital (5–10 km: OR 0.85, 95 % CI 0.79–0.91; >10 km: OR 0.85, 95 % CI 0.80–0.91), and not being exposed to social media publicity (OR 0.63, 95 % CI 0.53–0.75). Overall, 8 colorectal cancers (0.10 %), 423 advanced adenomas (5.38 %), 820 nonadvanced adenomas (10.43 %), and 684 hyperplastic polyps (8.70 %) were detected, with an adenoma detection rate of 15.92 %. Several factors, including older age, male, current smoking and a family history of colorectal cancer, were positively related to colorectal neoplasms. ConclusionsThe uptake of colonoscopy for colorectal cancer screening was not optimal among a socioeconomically diverse high-risk population. The screening strategy should attempt to ensure equitable access to screening according to regional characteristics, and enhance the uptake of colonoscopy by recommended multifaceted interventions, which focus on individuals with poor compliance, select a closer screening hospital, and strengthen social media publicity at the structural level.