Colorectal Cancer Screening Recommendations Research Articles

Population-level impact of the BMJ Rapid Recommendation for colorectal cancer screening: a microsimulation analysis

ObjectiveIn 2019, a BMJ Rapid Recommendation advised against colorectal cancer (CRC) screening for adults with a predicted 15-year CRC risk below 3%. Using Switzerland as a case study, we estimated...

Colorectal cancer information avoidance is associated with screening adherence.

Colorectal cancer (CRC) is the fourth most common cancer among U.S. men and women and the second deadliest. Effective screening modalities can either prevent CRC or find it earlier, but fewer than two thirds of U.S. adults are adherent to CRC screening guidelines. We tested whether people who defensively avoid CRC information have lower adherence to CRC screening recommendations and weaker intentions for being screened and whether CRC information avoidance adds predictive ability beyond known determinants of screening. Participants, aged 45-75 years, completed a survey about known structural determinants of CRC screening (healthcare coverage, healthcare use, provider recommendation), CRC information avoidance tendencies, and screening behavior (n = 887) and intentions (n = 425). Models were tested with multivariable regression and structural equation modeling (SEM). To the extent that participants avoided CRC information, they had lower odds of being adherent to CRC screening guidelines (OR = 0.55) and if non-adherent, less likely to intend to be screened (b=-0.50). In the SEM model, avoidance was negatively associated with each known structural determinant of screening and with lower screening adherence (ps < 0.01). Fit was significantly worse for nested SEM models when avoidance was not included, (i.e., the paths to avoidance were fixed to zero). Information avoidance was associated with screening behavior and other known structural determinants of screening adherence, potentially compounding its influence. Novel strategies are needed to reach avoiders, including health communication messaging that disrupts avoidance and interventions external to the healthcare system, with which avoiders are less engaged.

Dr. GPT will see you now: the ability of large language model-linked chatbots to provide colorectal cancer screening recommendations

Dr. GPT will see you now: the ability of large language model-linked chatbots to provide colorectal cancer screening recommendations

Comparative effectiveness of two interventions to increase colorectal cancer screening among females living in the rural Midwest.

To assess the comparative effectiveness of a tailored, interactive digital video disc (DVD) intervention versus DVD plus patient navigation (PN) intervention versus usual care (UC) on the uptake of colorectal cancer (CRC) screening among females living in Midwest rural areas. As part of a larger study, 663 females (ages 50-74) living in rural Indiana and Ohio and not up-to-date (UTD) with CRC screening at baseline were randomized to one of three study groups. Demographics , health status/history, and beliefs and attitudes about CRC screening were measured at baseline. CRC screening was assessed at baseline and 12 months from medical records and self-report. Multivariable logistic regression was used to determine whether females in each group were UTD for screening and which test they completed. Adjusted for covariates, females in the DVD plus PN group were 3.5× more likely to complete CRC screening than those in the UC group (odds ratio [OR] 3.62; 95% confidence interval [CI]: 2.09, 6.47) and baseline intention to receive CRC screening (OR 3.45, CI: 2.21,5.42) at baseline. Adjusting for covariates, there was no difference by study arm whether females who became UTD for CRC screening chose to complete a colonoscopy or fecal occult blood test/fecal immunochemical test. Many females living in the rural Midwest are not UTD for CRC screening. A tailored intervention that included an educational DVD and PN improved knowledge, addressed screening barriers, provided information about screening test options, and provided support was more effective than UC and DVD-only to increase adherence to recommended CRC screening.

A163 CATCHING CANCERS EARLY? AGE AND STAGE AT DIAGNOSIS OF COLORECTAL CANCER IN FIRST NATIONS PEOPLE IN ONTARIO COMARED TO OTHER ONTARIANS

Abstract Background Historically, Indigenous peoples in Canada were at lower risk for cancer compared to non-Indigenous people. Data from prior to 2010 suggested that First Nations in Ontario had higher incidence &amp; poorer survival from colorectal cancer (CRC). The current project arose from concerns raised by Indigenous partners about community members being diagnosed with colorectal cancer before screening age-eligibility. Aims To examine the age &amp; stage at CRC diagnosis among First Nations people in Ontario (FN) compared to other Ontarians (ON). Methods With Indigenous partner support, approvals were obtained to link health administrative datasets at ICES &amp; Ontario Health. Among others, these datasets included the Ontario Cancer Registry &amp; the Indian Register System, a registry of FN with status, meaning they are on the official record of persons registered under section 6 of Canada’s Indian Act. We created cohorts of FN &amp; ON aged 18-85 from 2000 to 2018, matched 1:5 on sex, age at &amp; year of inception. For the primary analysis, we performed survival analysis, accounting for the competing event of death &amp; using attained age as a time scale. The primary outcome was CRC diagnosis, the primary exposure was FN vs ON &amp; we adjusted for regular screening test use, comorbidity, remoteness &amp; having a regular primary care provider. Similarly, we examined stage at diagnosis, restricting the cohort to 2007+ due to limitations in the stage data. Results Baseline demographics for the 153,300 FN &amp; 766,500 ON included are in the Table. Median (IQR) follow-up was 17 (8-20) &amp; 18 (I8-20) years for FN &amp; ON, respectively (p ampersand:003C0.001). There were 1,156 (0.8%) &amp; 4,249 (0.6%) CRCs diagnosed in FN &amp; ON, respectively (p ampersand:003C0.001). 11,213 (7.3%) FN &amp; 25,732 (3.4%) ON died from other causes (p ampersand:003C0.001). After accounting for the competing event of death, FN were significantly more likely to be diagnosed with CRC at a younger age (HR 1.42, 95%CI: 1.32-1.53) (see Figure) &amp; later stage (HR 1.53, 95%CI: 1.34-1.75) than ON. Conclusions FN with CRC were younger &amp; presented at a later stage compared to ON with CRC. These findings have important implications for CRC screening recommendations for First Nations people in Ontario. Baseline characteristics at cohorts inception IQR, interquartile range A. Cumulative incidence of colorectal cancer (primary event) &amp; death (competing event), comparing First Nations (FN) and other Ontarians (ON). B. Focus on cumulative incidence of colorectal cancer (death as competing event, not shown), comparing FN and ON. Funding Agencies CIHR

Colorectal Cancer Prevention: Is Chat Generative Pretrained Transformer (Chat GPT) ready to Assist Physicians in Determining Appropriate Screening and Surveillance Recommendations?

To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations. Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services. An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app. The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001]. Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.

Impact of revising colorectal cancer screening guidelines on health care resources in Canada.

78 Background: The rising incidence of early-onset colorectal cancer (CRC) has prompted U.S. organizations to lower the recommended CRC screening age for average risk adults from 50 to 45 years old, while Canadian programs remain unchanged. Canadian guidelines also differ from the U.S. in preferentially screening with a fecal immunochemical test (FIT) and recommending against colonoscopies as a screening test. Differences in national healthcare administration warrants investigation into the resource impact of updating screening guidance in Canada. Methods: Microsimulation modeling was performed using OncoSim (version 3.6) to project health and economic outcomes of different CRC screening strategies based on Canadian population data. Four simulated birth cohorts of the Canadian population born between 1973–1992 were tracked for a 40-year span from the year the oldest in each cohort turned 40 until the youngest in the same cohort turned 75. Colorectal adenoma rates were adjusted according to cohort risk ratios estimated from historical incidence data to reflect real-world CRC rates. Outcomes were reported for the cumulative cohort. Results: Compared to FIT screening at age 50, FIT screening at 45 reduced deaths by 5,220, incidence by 11,980, and added 96,100 health-adjusted life years (HALY). Colonoscopy screening at age 45 led to 17,870 fewer deaths, 74,250 fewer cases and added 314,960 HALYs. FIT and colonoscopy screening at age 45 had incremental costs of CAD$3,259 and $7,881 per HALY gained vs. a FIT at age 50, respectively. Across screening strategies, the greatest benefits were observed in the youngest cohort. Colonoscopy screening at age 45 resulted in 10,679,540 more total colonoscopies than the current capacity of 8,966,979 with FIT screening at age 50. Lowering the screening age to 45 with a FIT increased colonoscopy demand by 329,555. The total cost of CRC care (screening, diagnosis and treatment) increased with lower screening ages and colonoscopy first modalities, while the cost of CRC management (diagnosis and treatment) decreased with lower screening ages and colonoscopy first approaches. Conclusions: Adjusting current CRC screening guidelines demonstrates significant resource implications with proportional health benefits. Lower screening ages and colonoscopy first approaches have the largest resource demand and greatest health outcomes, while the incremental cost per HALY gained for all screening strategies is modest compared to standard benchmarks. [Table: see text]

An Introduction to Clinical Informatics for Early Medical Learners Using Colorectal Cancer Screening.

Clinical informatics is an important component of the AMA-endorsed third pillar of undergraduate medical education, health systems science. Discrete educational opportunities for clinical informatics and health systems science among early learners are lacking in medical school curricula. We developed and evaluated a multistep, 2.5-hour activity during the gastroenterology module to introduce these topics to preclerkship medical students. A didactic session introducing clinical informatics and clinical decision support and reviewing health promotion and screening concepts was followed by small-group activities. Students worked through a series of exercises culminating in the generation of a clinical decision support tool based on the United States Preventive Services Task Force (USPSTF) colorectal cancer screening recommendations. Between 2022 and 2023, 326 first-year medical students participated in this workshop. Feedback was predictably mixed. In 2022, 88% of postclass survey respondents confirmed having a better clinical informatics understanding after the workshop. In 2023, students reported a statistically significant increase in their self-reported understanding of the role of clinical informatics, clinical decision support, and USPSTF colorectal cancer recommendations. Clinical decision support is a viable pathway for introduction of clinical informatics, health systems science, and public health/prevention topics. Our educational approach offers an interactive introduction to this group of topics that can benefit future physicians. While colon cancer provides a robust option for the clinical situation, this activity could be modified to fit into many different clinical scenarios, allowing for interdisciplinary education during either undergraduate or graduate medical education.

Abstract C019: Comparing the effectiveness of different community education approaches on colorectal cancer knowledge

Abstract Introduction: Colorectal cancer (CRC) incidence and mortality varies greatly among racial/ethnic groups nationally. Community outreach and education are effective strategies to enhance knowledge of CRC and have been shown to increase screening for CRC. The University of New Mexico Comprehensive Cancer Center implements Screen to Save, a community-based CRC screening initiative through the National Outreach Network Program. During the COVID-19 pandemic, restrictions on in-person engagement led to the development and implementation of alternative delivery strategies. Our site continued in-person education as possible, and added Zoom and fully self-paced via QR code options for community member participation. Very little is known regarding the effectiveness of different delivery modes. The purpose of this research is to examine the relationship between method of education session delivery and participant CRC knowledge. Methods: Participants were recruited via community organizations, Facebook advertising, and referrals from local stakeholders. Both before and after a standardized health education session, participants completed a survey assessing their knowledge of CRC risk and screening recommendations. Participant demographics were descriptively summarized. Estimates of mean changes, and 95% confidence intervals (CI), were obtained for each content delivery type. Differences in these changes were compared using ANCOVA approaches. Results: There were 239 participants who completed the educational sessions in-person (n=81), via Zoom (n=66), or using the self-paced module (n=92), Groups did not differ significantly in composition for age (p=0.72) or gender (p=0.33), but did differ in race, ethnicity, and education level (p&amp;lt;0. 001). Those who participated in any delivery method improved their knowledge scores by 11.6 (95% CI: 9.9-13.3) percentage points. For in-person, Zoom, and self-paced groups, the improvements were 14.1 (95% CI: 10.6-17.6, p&amp;lt;0.001), 11.5 (95% CI: 9.1-13.8, p&amp;lt;0.001), and 9.4 (95% CI: 6.7-12.1, p&amp;lt;0.001) percentage points, respectively. When comparing pre vs post score differences among session types while adjusting for pre scores, and for baseline differences in race, ethnicity, and education, the differences in improvement for the three different session types were not significantly different (p=0.68). For in-person, Zoom, and self-paced groups adjusted improvements were 9.2 (95% CI: 0.5-17.5), 11.1 (95% CI: 1.9-19.8), and 10.1 (95% CI: 1.5-18.3) percentage points, respectively. Conclusion: Health education sessions delivered in person, via Zoom, and by self-paced online modules are associated with increases in participant knowledge of CRC. As Cancer Centers expand community outreach and engagement to address cancer health disparities in their catchment areas, a better understanding of the relative effectiveness of different delivery strategies is needed. Further research will help to discern population characteristics predictive of different strategies and link these approaches to screening uptake. Citation Format: Lila A. Baca, Yadira Aguero, Angelica Solares, Vernon Shane Pankratz, Shiraz I. Mishra, Miria Kano, Andrew L. Sussman. Comparing the effectiveness of different community education approaches on colorectal cancer knowledge [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C019.

The relationship of cancer history and chronic disease status to colorectal cancer screening: A cross-sectional analysis of 2020-2021 Behavioral Risk Factor Surveillance System.

We examined whether having a history of cancer and chronic diseases was associated with guideline-concordant colorectal cancer (CRC) screening utilization. Self-reported data from the 2020 and 2021 Behavioral Risk Factor Surveillance System in Oregon and West Virginia were used. Guideline-concordant CRC screening was the outcome of interest. The exposure was having a personal history of cancer, chronic diseases, or both. Multivariable logistic regressions were applied to assess the abovementioned association. Among 10,373 respondents aged 45-75years, 75.5% of those with a history of cancer and chronic diseases had guideline-concordant CRC screening use versus 52.8% of those without any history (p-value < 0.05). In multivariable analysis, having a history of cancer (OR 1.74; 95% CI 1.11-2.71), chronic diseases (OR 1.35; 95% CI 1.14-1.59), and both cancer and chronic diseases (OR 2.14; 95% CI 1.62-2.82) were positively associated with screening uptake compared to respondents without any history. Regardless of disease history, older age was associated with greater CRC screening uptake (p-value < 0.05). Among respondents with chronic diseases only or without any condition, those with a health care provider had 1.7-fold and 2.7-fold increased odds of receiving CRC screening, respectively. However, current smokers were 28% and 34% less likely to be screened for CRC among those with chronic diseases only and without any conditions, respectively. Having a personal history of cancer and chronic diseases appears to be positively associated with guideline-concordant CRC screening use. Effective implementation of patient-centered communication through primary care initiatives may increase adherence to CRC screening recommendations.

Patterns of colorectal cancer screening and adherence rates among an average-risk population enrolled in a national health insurance provider during 2009–2018 in the United States

While colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (US), outcomes can be improved through timely screening. Despite the benefits and widespread availability of screening tests, adherence to recommended screening strategies is low. The study aimed to provide recent evidence regarding screening rates and adherence to screening recommendations among adults at average risk for CRC in a commercially insured and Medicare Advantage population. De-identified administrative data from a large US research database were examined to determine screening rates for the years 2009 through 2018. The study population included adults aged 50–75 years and annual study population counts ranged from 1,390,594 in 2009 to 1,654,544 in 2018. Incident screening rates were found to be relatively stable across the study years (approximately 15 %) with adherence lowest in the youngest age group (ages 50–54 years). Colonoscopies accounted for approximately 50 % of all screening tests performed, while there was a substantial increase in the use of home-based screening tests over the study timeframe. The use of the fecal immunochemical test increased from 17.2 % in 2009 to 28.9 % in 2018 and the multi-target stool DNA test increased from 0.4 % in 2015 to 9.0 % in 2018. Overall though, CRC screening and adherence rates remain relatively low among adults at average risk for CRC in the US. Improving adherence rates with CRC screening recommendations among individuals at average risk for CRC is required to improve health outcomes.

A Moderating Role of Gender in Online Health Information Seeking Behaviors for Colorectal Cancer Knowledge among Korean Americans Aged 50 to 75 Years

ABSTRACT Korean Americans have consistently reported the underutilization of colorectal cancer (CRC) screening, despite their high rates of CRC incidence and mortality. Research has indicated suboptimal CRC knowledge in Korean Americans as one of the main barriers to their recommended CRC screening. Also, research has shown the potential of online health information seeking (OHIS) to improve cancer knowledge and gender-based differences in the link between OHIS and cancer knowledge. Thus, this study aimed to examine the association between OHIS and CRC knowledge and the moderating effect of gender in this association among Korean Americans. A cross-sectional survey with purposive sampling was conducted of 421 Korean Americans aged 50–75 years in the Southeastern U.S. Three-step hierarchical multiple-regression analyses were performed to investigate if three blocks of variables—Block 1: control variables (sociodemographics and health-related information), Block 2: independent variables (OHIS and gender), and Block 3: an (OHIS × gender) interaction term—significantly reduce unexplained variance in CRC knowledge. The analyses showed that the final model fits best accounting for 29.3% of the variance in CRC knowledge. Also, the analyses showed that OHIS was positively associated with CRC knowledge and gender moderated the association between OHIS and CRC knowledge. The findings close the knowledge gap existing in the body of literature on the connection of OHIS to CRC knowledge in Korean Americans. The findings also extend the understanding of gender-specific approaches leveraging OHIS for CRC prevention education among Korean Americans.

Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021.

We examined national estimates of breast, cervical, and colorectal cancer (CRC) screening test use and compared them with Healthy People 2030 national targets. Test use in 2021 was compared with prepandemic estimates. In 2022, we used 2021 National Health Interview Survey (NHIS) data to estimate proportions of adults up to date with US Preventive Services Task Force recommendations for breast (women aged 50-74 y), cervical (women aged 21-65 y), and CRC screening (adults aged 50-75 y) across sociodemographic and health care access variables. We compared age-standardized estimates from the 2021 and 2019 NHIS. Percentages of adults up to date in 2021 were 75.7% (95% CI, 74.4%-76.9%), 75.2% (95% CI, 73.9%-76.4%), and 72.2% (95% CI, 71.2%-73.2%) for breast, cervical, and CRC screening, respectively. Estimates were below 50% among those without a wellness check in 3 years (all screening types), among those without a usual source of care or insurance (aged <65 y) (breast and CRC screening), and among those residing in the US for less than 10 years (CRC screening). Percentages of adults who were up to date with breast and cervical cancer screening and colonoscopy were similar in 2019 and 2021. Fecal occult blood/fecal immunochemical test (FOBT/FIT) use was modestly higher in 2021 (P < .001). In 2021, approximately 1 in 4 adults of screening age were not up to date with breast, cervical, and CRC screening recommendations, and Healthy People 2030 national targets were not met. Disparities existed across several characteristics, particularly those related to health care access. Breast, cervical, and colonoscopy test use within recommended screening intervals approximated prepandemic levels. FOBT/FIT estimates were modestly higher in 2021.

Receipt of Clinician Recommendation for Colorectal Cancer Screening Among Underscreened U.S. Adults.

Receipt of Clinician Recommendation for Colorectal Cancer Screening Among Underscreened U.S. Adults.

Colorectal cancer screening: The role of MT-sDNA testing.

Because an estimated 10.5% of new colorectal cancer (CRC) cases occur in patients under age 50 years, the US Preventive Services Task Force in 2021 recommended CRC screening for adults ages 45 to 49 years. The prevalence of up-to-date CRC screening with any recommended test among patients age 45 years and older in the United States is only 59% in 2023, indicating that existing screening practices are ineffective. Screening options now include invasive and noninvasive measures. Multi-target stool DNA (MT-sDNA) testing is a simple, low-risk, noninvasive test that provides excellent sensitivity and specificity, is cost-effective, and may increase patient screening rates. CRC screening guideline recommendations and alternative screening methods may help improve patient outcomes and reduce morbidity and mortality. This article describes MT-sDNA testing, its effectiveness, recommended use, and potential expanding role as a screening option.

Colorectal cancer and digital/live screening navigation: Promoting prevention through personalized recommendations and access.

10566 Background: This project evaluates the effectiveness of an advocacy organization-led digital and live navigation framework aimed at colorectal cancer (CRC) screening completion. The Colorectal Cancer Alliance’s screening quiz guides patients to a clinically valid, personalized CRC screening recommendation with a handoff to live navigation for those at risk. The framework utilizes digital innovation, targeted awareness, and financial support to support populations experiencing the greatest disparities and increase screening intention, behavior, and further health equity in colorectal cancer. This simple intervention is critical due to existing research consistently indicating on-time screening for CRC leads to favorable outcomes. Methods: In July 2022, the Alliance launched an enhanced quiz to improve the CRC screening navigation experience and increase engagement. The new survey instrument was restructured to streamline time to completion while preserving clinically accurate risk stratification. The follow-up navigation protocol was reordered from digital-first to live-first to leverage high-touch strategies earlier in the screening journey and dynamic content was added to the recommendation page to create a more personalized resource. The Alliance also deployed social media and influencer campaigns to increase outreach to at-risk communities. Results: The enhanced quiz delivered over 8,300 CRC screening recommendations and improved the average monthly completion rate (33%) and contact capture rate (14.4%) compared to the previous quiz in 2022 (24%; 8%). The median age of respondents was 55, and 37.2% of the respondents were between the ages of 45 and 64. Of the respondents, 26.7% were male and 73.3% were female. The majority were White (77.1%), 7.3% identified as Black/African American, 5.5% were Hispanic or Latino, and 3% were Asian. Most respondents were symptomatic (67.8%) but 8.1% were asymptomatic high-risk. Respondents (1,078) were triaged to live Alliance patient navigation. Conclusions: This digital and live navigation framework may serve as a strong solution in driving colorectal cancer screening and supporting shared-decision making conversations compared to other available interventions. The framework provides users with robust access to live navigation, educational resources, and support services for CRC screening and diagnosis. The Alliance is uniquely positioned to utilize its communications channels, social media and influencer campaigns to reach at-risk communities with credibility. Data attributed to specific campaigns are still being analyzed, and the Alliance will continue to optimize its navigation protocol and awareness efforts as quality improvement processes allow for a deeper understanding of more inclusive and impactful navigation experiences to close screening gaps among at-risk populations.

P294 Colorectal cancer screening in cystic fibrosis, what can iFOBT tell us?

Patients with cystic fibrosis (CF) have increased risk of colorectal cancer (CRC). The utility of faecal occult blood testing (iFOBT) as a screening test is unclear. Colonoscopy is the current recommended CRC screening test in CF. This is a preliminary report of an ongoing study and aims to evaluate the role of iFOBT in adults with CF requiring CRC screening.

The Ohio State University Guardant Shield Colorectal Cancer Screening Project.

TPS3626 Background: Asymptomatic screening is an effective method for detecting early cancers when prognosis strongly depends on stage at time of diagnosis. Unscreened individuals often have a basic understanding of the importance and availability of colorectal cancer (CRC) screening but have concerns regarding the collection method of the currently available stool-based options or the invasiveness of direct visualization options that deter test completion. We hypothesize that offering a blood-based CRC screening test during a routine healthcare visit can increase screening adherence, especially within hard-to-reach populations and those hesitant about completing CRC screening. Methods: The Ohio State University Guardant Shield Colorectal Cancer Screening Project (NCT05716477) is a prospective study in the United States designed to recruit individuals who are currently engaging with mobile health clinics and are not up to date with CRC screening, with the aim of improving health in hard-to-reach populations. The study’s primary objective is to evaluate the acceptance of a commercially available blood-based CRC screening test (Shield, Guardant Health, USA) in individuals aged 45-84, who have existing appointments with a mobile health clinic, and are not up to date with guideline recommended CRC screening. The study team screens for eligibility criteria before the appointment and reaches out to the individual to begin the informed consent process. Positive blood-based test results will be triaged to colonoscopy for further evaluation. A post-study survey will be administered to consented individuals aimed to collect data on CRC screening knowledge which will be correlated to patient demographics and uptake. Acceptance will be defined as those approached and with completed specimen collection. Progress: The study initiated on October 25, 2022, with the first patient enrolled on December 20, 2022. Enrollment is expected to continue with a target enrollment of 300 individuals. Clinical trial information: NCT05716477 .

Disparities in Compliance with Colorectal Cancer Screening: Evidence from Two US National Surveys.

Colorectal cancer (CRC) is the most preventable cancer if adherence to its screening guidelines through compliance with physician recommendations are met. Lack of access to care is the most significant barrier which was decreased by the Affordable Care Act (ACA), that may influence healthcare behaviors/practices. The aim of this study was to determine the factors affecting compliance with recommendations for CRC screening between two US National Health Interview Surveys (NHIS) in 2010 and 2015. We used individual data of adults aged ≥50 years from the Cancer Module of NHIS that repeats every-5-years. Multiple logistic regression analyses were employed to identify the compliance associated factors and their changes after five years. We included final data of 1,553 and 2259 and individual from 2010 and 2015, respectively. Overall, compliance to physician recommendations for colorectal cancer was 85.70% in 2010 and 81.54%. Men compiled more in 2010 than women which was reversed in 2015. The multivariable-adjusted odds of compliance were increased with age; lower for female [Odds ratio (OR)= 0.45 Confidence Interval (CI 95% 0.27, 0.75), having a family history of CRC [OR=3.05 CI:1.02, 9.05], having insurance [OR 3.58 CI:1.4, 9.12], and Odds increased with the number of doctor visit in 2010. However, in 2015 the odds were substantially increased with the increasing age, reversed odds for female [OR= 3.49 CI: 1.67, 7.29)], increased for non-Hispanic Blacks [OR= 4.87 CI: 2.05, 11.55] and lower for Asian [OR=0.33 CI:0.15, 0.74], higher for family history of colorectal cancer [OR=3.31 CI:1.92, 5.69]. Although insurance coverage and the number of doctor visits were significant predictors of compliance in 2010, those became non-significant in 2015. Compliance disparities by gender and access to healthcare either reduced in strength or reversed between 2010 and 2015. The non-Hispanic Black significantly higher in compliance than other race-ethnicities in 2015.

Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart?

Current colorectal cancer (CRC) screening recommendations take a "one-size-fits-all" approach using age as the major criterion to initiate screening. Precision screening that incorporates factors beyond age to risk stratify individuals could improve on current approaches and optimally use available resources with benefits for patients, providers, and health care systems. Prediction models could identify high-risk groups who would benefit from more intensive screening, while low-risk groups could be recommended less intensive screening incorporating noninvasive screening modalities. In addition to age, prediction models incorporate well-established risk factors such as genetics (eg, family CRC history, germline, and polygenic risk scores), lifestyle (eg, smoking, alcohol, diet, and physical inactivity), sex, and race and ethnicity among others. Although several risk prediction models have been validated, few have been systematically studied for risk-adapted population CRC screening. In order to envisage clinical implementation of precision screening in the future, it will be critical to develop reliable and accurate prediction models that apply to all individuals in a population; prospectively study risk-adapted CRC screening on the population level; garner acceptance from patients and providers; and assess feasibility, resources, cost, and cost-effectiveness of these new paradigms. This review evaluates the current state of risk prediction modeling and provides a roadmap for future implementation of precision CRC screening.