Colorectal Cancer Screening Uptake Research Articles

Analysis of the effectiveness of two noninvasive fecal tests used to screen for colorectal cancer in average-risk adults

ObjectivesColorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Although a significant proportion of CRC cases and deaths are preventable by screening, the morbidity and mortality from CRC remains high and is attributed to suboptimal screening rates. Low levels of population CRC screening uptake may be due to reluctance toward invasiveness of some screening tests, embarrassment, exposure to anesthesia, and grueling preparation, especially for the invasive screening tests. Noninvasive tests overcome many of these barriers because they are more convenient and potentially more attractive to patients compared to invasive tests. This study uses Markov cohort simulation model developed with the help of TreeAge pro software to compare two noninvasive fecal CRC screens, fecal immunohistochemical test (FIT) and multitarget stool DNA test (Mt-sDNA) with no screening in order to identify the more effective noninvasive fecal test to screen for colorectal cancer in average-risk adults. Study designSimulation study developed with Markov model using TreeAge pro software, which included a hypothetical cohort at the average risk of developing colorectal cancer. MethodsMarkov model was used to compare population-level CRC-related cases and deaths averted, life-years gained (LYG), and colonoscopies required for two noninvasive CRC screening strategies compared with no screening: annual fecal immunohistochemical testing (FIT) and 3-yearly multitarget stool DNA testing (Mt-sDNA). The model simulated the natural history of the adenoma-carcinoma sequence in average-risk persons starting at age 50 years, and natural history parameters were estimated from the literature and via verification to data on precancerous lesions (i.e. adenomas) and CRC incidence. Screening strategies were then superimposed on the natural history component of the model, allowing for precancerous lesions to be detected and removed, or CRC to be detected and treated at a potentially earlier stage. The sensitivity and specificity for each screen for precancerous lesions and CRC were the performance parameters used to estimate the effectiveness. ResultsAnnual FIT was more effective than three yearly Mt-sDNA in reducing CRC cases, averting CRC-related deaths, and increasing the LYG compared to no screening. On average, annual FIT resulted in 3.5 fewer CRC cases, and 2.9 fewer CRC deaths per 1000 persons screened compared to 3-yearly Mt-sDNA. Annual FIT usage resulted in a 0.18 LYG compared to Mt-sDNA, which allowed 0.16 LYG, and an annual FIT screening led to a total of 203 more colonoscopies performed compared to Mt-sDNA. One-way sensitivity analysis conducted over the sensitivity rates of each screen by type of lesion showed that FIT remained the more effective strategy for all ranges of sensitivity. Threshold analysis results identified the lowest FIT sensitivity value at which Mt-sDNA performed better for conventional high-risk adenomas and CRC detection to be 0.16 and 0.052, respectively. ConclusionBoth the noninvasive screens were effective compared to no screening. Additionally, annual FIT as a first step noninvasive screening test for CRC appears to be more effective compared to three-yearly Mt-sDNA.

A risk prediction tool for colorectal cancer screening: a qualitative study of patient and provider facilitators and barriers

BackgroundDespite proven effectiveness of colorectal cancer (CRC) screening, at least 35% of screen-eligible adults are not current with screening. Decision aids and risk prediction tools may help increase uptake, adherence, and efficiency of CRC screening by presenting lower-risk patients with options less invasive than colonoscopy. The purpose of this qualitative study was to determine patient and provider perceptions of facilitators and barriers to use of a risk prediction tool for advanced colorectal neoplasia (CRC and advanced, precancerous polyps), to maximize its chances of successful clinical implementation.MethodsWe conducted qualitative, semi-structured interviews with patients aged 50–75 years who were not current with CRC screening, and primary care providers (PCPs) at an academic and a U.S. Department of Veterans Affairs Medical Center in the Midwest from October 2016 through March 2017. Participants were asked about their current experiences discussing CRC screening, then were shown the risk tool and asked about its acceptability, barriers, facilitators, and whether they would use it to guide their choice of a screening test. The constant comparative method guided analysis.ResultsThirty patients and PCPs participated. Among facilitators were the tool’s potential to increase screening uptake, reduce patient risk, improve resource allocation, and facilitate discussion about CRC screening. PCP-identified barriers included concerns about the tool’s accuracy, consistency with guidelines, and time constraints.ConclusionsPatients and PCPs found the risk prediction tool useful, with potential to increase uptake, safety, and efficiency of CRC screening, indicating potential acceptability and feasibility of implementation into clinical practice.

Predicting Workplace Fecal Occult Blood Test Screening Uptake using Generalized Estimating Equations: A Sensitivity Analyses

Introduction: Many studies have shown the effectiveness of educational modules on increasing colorectal cancer screening uptake at individual level but not adjusted for potential clustering effect such as workplace. Longitudinal studies on workplace colorectal cancer screening require a series of analysis under different conditions due to heterogeneity of workplace population. To achieve this, a sensitivity analysis based on Generalized Estimating Equations was conducted to determine the robustness of the predictive performance of health education module in increasing screening uptake. Materials and Method: A parallel, single blind, cluster randomized trial was conducted among 15 organizations in Kuantan, Pahang. Intervention group received a complex Health Education Module comprising of group education, practical session on fecal occult blood test usage and WhatsApp group follow-up, while control group received standard colorectal cancer screening brochure. Sensitivity analyses using intention to treat analysis with interaction term, compatibility term, behavioral intention term and key assumption term were performed. Data were imputed and analysed using generalized estimating equation with IBM SPSS version 23. Pooled adjusted odds ratio was calculated using random effect model with inverse variance weighting using RevMan version 3.5. Results: A total of 166 participants from 15 organizations were recruited in the study. Intervention and control group were comparable at baseline (P>0.05). Health Education Module given in intervention group significantly increased the uptake of FOBT by nearly 5 times compared to control group in sensitivity analyses (pooled adjusted OR=4.60, 95% CI=2.65-7.99, I2=47%, P<0.001). Conclusions: Health Education Module was robust in facilitating fecal occult blood test uptake in different predictive models. Health Education Module should be implemented as a workplace health promotion program to improve colorectal cancer screening for early detection and prompt treatment.

Association of Race and Socioeconomic Status With Colorectal Cancer Screening, Colorectal Cancer Risk, and Mortality in Southern US Adults

Colorectal cancer (CRC) screening is rarely studied in populations who may face additional barriers to participate in cancer screening, such as African American individuals and individuals with low socioeconomic status (SES). To examine the associations of CRC screening and modalities with CRC incidence and mortality by race and SES. This cohort study used data from the Southern Community Cohort Study, which enrolled more than 85 000 participants from community health centers or stratified random sampling of the general population in 12 states in the southeastern United States. The present study included data from cohort members who were eligible for CRC screening as recommended by expert organizations based on age and family history. Participants completed questionnaires from 2002 to 2009 and were contacted again from 2008 to 2012. Linkages to state cancer registries and the National Death Index as of December 31, 2016, identified incident CRC and vital status. Data analysis was performed from January 1, 2018, to October 30, 2019. Incident CRC (n = 632) and mortality (n = 10 003). Cox proportional hazards regression models evaluated associations between screening modalities and CRC risk and mortality. Information on fecal occult blood test use was only obtained on the follow-up questionnaire. Self-identified race was measured as African American/black, white, or other, and SES was defined by household income. This study included 47 596 participants (median baseline age, 54 years [interquartile range, 10 years]; 32 185 [67.6%] African American; 28 884 [60.7%] female; and 26 075 [54.8%] with household income <$15 000). A total of 24 432 participants (63.9%) had never undergone CRC testing at baseline. The CRC testing assessed at baseline and follow-up interviews was associated with significant CRC risk reduction (hazard ratio [HR], 0.55; 95% CI, 0.44-0.70 for ever colonoscopy at baseline). Results were similar in analyses stratified by race (African American: HR, 0.65; 95% CI, 0.50-0.85; white: HR, 0.44; 95% CI, 0.27-0.70) and household income (<$15 000: HR, 0.63; 95% CI, 0.46-0.86, ≥$15 000: HR, 0.49; 95% CI, 0.35-0.69). Ever sigmoidoscopy at baseline was associated with CRC risk reduction (HR, 0.66; 95% CI, 0.51-0.87), and undergoing fecal occult blood test in the interval between baseline and follow-up interview was associated with CRC risk reduction (HR, 0.75; 95% CI, 0.57-0.98). Inverse associations were also observed between CRC mortality and receipt of colonoscopy (HR for women, 0.39; 95% CI, 0.21-0.73; HR for men, 0.69; 95% CI, 0.40-1.18) and sigmoidoscopy (HR for women, 0.37; 95% CI, 0.16-0.85; HR for men, 0.82; 95% CI, 0.46-1.47); however, the association did not extend to fecal occult blood test (HR for women, 1.02; 95% CI, 0.62-1.70; HR for men, 1.03; 95% CI, 0.55-1.93). In this study, CRC test rates were low among African American individuals and those with low SES. The findings suggest that screening, particularly with colonoscopy, is significantly associated with reduced risk of CRC and mortality. The CRC disparities experienced by individuals with low SES and African American individuals may be lessened by improving access to and uptake of CRC screening.

Patient-Centered Medical Home and Up-To-Date on Screening for Breast and Colorectal Cancer

Effectiveness of the patient-centered medical home model for promoting cancer screening utilization is uncertain, with prior research showing mixed results. Using national patient-provider pair data, this study examined whether having a patient-centered medical home-certified provider influences receipt of recommended screening for breast and colorectal cancer. A cross-sectional analysis was performed in 2019 on data from the 2015-2016 Medical Organizational Survey and Medicare Expenditure Panel Survey. Participants included U.S. adults aged 50-75 years who met screening guidelines from the U.S. Preventive Services Task Force. Multivariable regression models estimated the up-to-date rates of breast cancer and colorectal cancer screening between the patient-centered medical home and non-patient-centered medical home groups. The study sample comprised 4,052 patient-provider pairs, representing a weighted 40.1 million screening-eligible individuals cared for by 2,314 practices. Of those, 1,909 (48.2%) were cared for by patient-centered medical home-certified providers. Unadjusted up-to-date rates were similar between patient-centered medical homes and non-patient-centered medical homes (breast cancer screening, 85.4% vs 83.4%; colorectal cancer screening, 73.3% vs 73.3%). Adjusted analysis indicated no significant differences in rates of breast cancer (p=0.228) or colorectal cancer screening (p=0.878). In subgroup analyses, however, having a patient-centered medical home-certified provider was associated with higher screening rates among individuals aged 50-64 years and those with a private plan for breast cancer and among other racial/ethnic minorities for colorectal cancer. Obtaining care from a patient-centered medical home-certified provider is not associated with increased breast cancer or colorectal cancer screening uptake. Findings of this study suggest that tailoring cancer screening strategies to patient mix may be needed to improve cancer screening utilization in patient-centered medical homes.

Colorectal cancer screening uptake among US Latino subgroups

Purpose The purpose of this paper is to study the colorectal cancer (CRC) screening practices of Latinos in the USA, a traditionally disadvantaged group regarding health, while operating within the theoretical lens of segmented acculturation. Differential acculturation experiences influence migrant health and healthcare access, including CRC screening. Design/methodology/approach Latinos are categorized into subgroups and are referenced against non-Latino whites and non-Latino blacks. Descriptive statistics and binomial logistic regression models are used to analyze the data from the 2008 and 2010–2014 National Health Interview Survey. Findings Latinos and respondents born outside of the non-territorial USA exhibit disparities in CRC screening participation. Screening discrepancies are not uniform across Latino subgroups, reflecting the importance of a segmented acculturation theoretical lens. Practical implications A discrepancy exists in CRC screening utilization among the largest minority population in the USA. These inconsistencies among US Latinos must be addressed directly to avoid serious health consequences in a large and growing population. Originality/value Interventions should be tailored to address the unique situational contexts of Latino subgroups suffering the health disparities. These distinct contexts are only elucidated through the use of a theoretical lens of segmented acculturation in studies of Latino health, which explicitly considers the historical and contemporary social forces acting upon the subgroups. This study extends beyond individual-level exposures to provide a more holistic view of the health behaviors and outcomes among Latino subgroups in the USA. Insight gained from this study is invaluable to improving the health of these traditionally disadvantaged groups.

Uptake of Colorectal Cancer Screening by Physicians Is Associated With Greater Uptake by Their Patients

Physicians' own screening practices might affect screening in their patients. We conducted a population-based study to evaluate whether family physicians who underwent colorectal cancer testing were more likely to have patients who underwent colorectal cancer testing. We collected demographic and health care information on residents of Ontario, Canada from administrative databases; the sample was restricted to individuals at average risk of colorectal cancer who were 52-74 years old as of April 21, 2016. We obtained a list of all registered physicians in the province; physicians (n= 11,434) were matched with nonphysicians (n= 45,736) on age, sex, and residential location. Uptake of colorectal tests was defined by a record of a fecal occult blood test in the past 2 years, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. Patients were assigned to family physicians based on billing claim frequency, and then the association between colorectal testing in family physicians and their patients was examined using a modified Poisson regression model. Uptake of colorectal tests by physicians and nonphysicians (median age 60 years; 71% men) was 67.9% (95% confidence interval [CI], 67.0%-68.7%) and 66.6% (95% CI, 66.2%-67.1%), respectively. Physicians were less likely than nonphysicians to undergo fecal occult blood testing and were more likely to undergo colonoscopy; prevalence ratios were 0.44 (95% CI, 0.42-0.47) and 1.24 (95% CI, 1.22-1.26), respectively. Uptake of colorectal tests by family physicians was associated with greater uptake by their patients (adjusted prevalence ratio, 1.10; 95% CI, 1.08-1.12). Approximately one-third of physicians and nonphysicians are overdue for colorectal cancer screening. Patients are more likely to be tested if their family physician has been tested. There is an opportunity for physicians to increase their participation in colorectal cancer screening, which could, in turn, motivate their patients to undergo screening.

Individual and Geospatial Characteristics Associated With Use and Nonuse of the Fecal Immunochemical Test (FIT) for Colorectal Cancer Screening in an Urban Minority Population.

Initiatives by the Centers for Disease Control and Prevention as well as the National Colorectal Cancer Roundtable aim to increase the rate of colorectal cancer (CRC) screening. We assess individual and geographic characteristics associated fecal immunochemical test (FIT) CRC screening over 3 years. This is a retrospective study of 1500 FIT kits which were mailed or opportunistically handed to eligible participants in Brooklyn, New York from January 2014 to December 2016. Eligibility criteria included increased risk for colon cancer, uninsured or underinsured, and a minimum age of 50 years to warrant CRC screening. We looked at the association of individual demographic characteristics and FIT screening by logistic regression using SPPS version 23 software. In addition, using ArcGIS, we coded patients address and layered census tract population information to find associations. In total, 1367 Cancer Services Participants met our study criteria. The study sample was predominantly female (95.2%) and minority (46% African American, 24.7% Hispanic, 17.3% Caucasian, 11.4% Asian) and on average 59 years old (SD, 5.7). A large majority (73%) had household incomes below $20,000/year. Approximately half (49.9%) of all Cancer Services Participants returned their FIT kit. In participants who did not return their FIT kit, the majority were African American (41%), followed by Hispanics (26.5%), Caucasians (20.6%), and Asians (11.8%). Multivariable logistic regression showed that a screening history of prior colonoscopy or FIT, gender, ethnicity, and educational attainment were significantly associated with FIT CRC screening uptake (P<0.05). Geospatial mapping showed clusters of low screening uptake in areas of high poverty. Hot-spot analysis identified areas of significant vulnerability. FIT uptake remains suboptimal. Individual predictors as well as area poverty is associated with low screening uptake. Geospatial mapping is an effective tool for evaluating CRC screening uptake.

Socio-cognitive determinants of colorectal cancer screening uptake: An application of intervention mapping approach

Socio-cognitive determinants of colorectal cancer screening uptake: An application of intervention mapping approach

Breast, cervical and colorectal cancer screening in adults with diabetes: a systematic review and meta-analysis.

Individuals with diabetes are at increased risk of developing and dying from cancer. Evidence-based guidelines recommend universal screening for breast, cervical and colorectal cancer; however, evidence on the uptake of these tests in individuals with diabetes is mixed. We conducted a meta-analysis to quantify the association between diabetes and participation in breast, cervical and colorectal cancer screening. MEDLINE, EMBASE and CINAHL were searched systematically for publications between 1 January 1997 and 18 July 2018. The search was supplemented by handsearching of reference lists of the included studies and known literature reviews. Abstracts and full texts were assessed in duplicate according to the following eligibility criteria: study conducted in the general population; diabetes included as a predictor vs a comparison group without diabetes; and breast (mammography), cervical (Papanicolaou smear) or colorectal (faecal and endoscopic tests) cancer screening uptake included as an outcome. Random-effects meta-analyses were performed using the most-adjusted estimates for each cancer site. Thirty-seven studies (25 cross-sectional, 12 cohorts) were included, with 27 studies on breast, 19 on cervical and 18 on colorectal cancer screening. Having diabetes was associated with significantly lower likelihood of breast (adjusted OR 0.83 [95% CI 0.77, 0.90]) and cervical (OR 0.76 [95% CI 0.71, 0.81]) cancer screening, relative to not having diabetes. Colorectal cancer screening was comparable across groups with and without diabetes (OR 0.95 [95% CI 0.86, 1.06]); however, women with diabetes were less likely to receive a colorectal cancer screening test than women without diabetes (OR 0.86 [95% CI 0.77, 0.97]). Our findings suggest that women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates, compared with women without diabetes, although the absolute differences might be modest. Given the increased risk of cancer in this population, higher quality prospective evidence is necessary to evaluate the contribution of diabetes to cancer screening disparities in relation to other patient-, provider- and system-level factors. PROSPERO registration ID CRD42017073107.

Physician-office vs home uptake of colorectal cancer screening using FOBT/FIT among screening-eligible US adults.

BackgroundGuidelines of the American Cancer Society and US Preventive Services Task Force specify that colorectal cancer (CRC) screening using guaiac‐based fecal occult blood test (FOBT)/fecal immunochemical test (FIT) should be done at home. We therefore examined the prevalence and correlates of CRC screening using FOBT/FIT in physicians' office vs at home.MethodsAnalysis of 9493 respondents 50‐75 years old from the Cancer Control Supplement of the 2015 National Health Interview Survey was conducted. Weighted multivariable logistic regression was used to identify the determinants of in‐office vs home use of FOBT/FIT for CRC screening.ResultsOf the overall sample of screening‐eligible adults (n = 9403), only 937 (10.4%) respondents underwent CRC screening using FOBT/FIT within the past year; among this screening population, 279 (28.3%) respondents were screened in‐office. We found that sociodemographic factors alone, not CRC risk factors, determined whether FOBT/FIT would be used in‐office or at home. Hispanics had greater odds of being screened in‐office using FOBT/FIT (aOR: 2.04; 95% CI: 1.05‐3.99). Compared with those 50‐59 years old, respondents 70‐75 years old were less likely to be screened in‐office using FOBT/FIT (aOR: 0.44, 95% CI: 0.25‐0.79). Similarly, individuals residing in the Western region of the country had lower odds of in‐office FOBT/FIT (aOR: 0.26; 95% CI: 0.11‐0.58).ConclusionAmid low overall uptake rates of FOBT/FIT in the United States, in‐physician office testing is high, indicative of a missed opportunity for effective screening and poor adherence of physicians to national guidelines. Sociodemographic factors are determinants of uptake of FOBT/FIT at home or in‐office and should be considered in designing interventions aimed at providers and the general population.

The role of ethnicity in Colorectal Cancer Screening uptake: A systematic review

The role of ethnicity in Colorectal Cancer Screening uptake: A systematic review

Testing the effectiveness of a general practice intervention to improve uptake of colorectal cancer screening: a randomised controlled trial

ObjectiveUptake of screening through the Australian National Bowel Cancer Screening Program remains low. General practice guidelines support the general practitioners’ role to offer CRC screening. This study tests the effect that an intervention including point‐of‐care FOBT provision, printed screening advice and GP endorsement has on self‐reported FOBT uptake. MethodsA multisite, 1:1 parallel‐arm, cluster‐randomised controlled trial. Participants aged 50–74, at average risk of CRC and overdue for screening were recruited from four general practices in New South Wales, Australia, from September 2016 to May 2017. Self‐report of FOBT up to eight weeks post baseline. ResultsA total of 336 participants consented to complete a baseline survey (64% consent rate), of which 123 were recruited into the trial (28 usual care days and 26 intervention days). Follow‐up data was collected for 114 participants (65 usual care and 49 intervention). Those receiving the intervention had ten times greater odds of completing screening compared to usual care (39% vs. 6%; OR 10.24; 95%CI 2.9‐36.6, p=0.0006). ConclusionsA multicomponent intervention delivered in general practice significantly increased self‐reported FOBT uptake in those at average risk of CRC. Implications for public healthGeneral practice interventions could serve as an important adjunct to the Australian National Bowel Cancer Screening Program to boost plateauing screening rates.

300 Predictors of Colonoscopy Use Among Chinese Americans: An Analysis of the New York City Community Health Survey (2003–2016)

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of cancer death among Asian Americans, who also have one of lowest rates of CRC screening. Chinese Americans are the largest Asian American subgroup in the United States (US), but there is a paucity of data examining predictors of CRC screening in this population. We used the New York City Community Health Survey (NYCCHS) to study factors associated with up-to-date colonoscopy use among Chinese Americans. METHODS: The NYCCHS is an annual population-based telephone survey. For this analysis, we included all Chinese Americans aged ≥50 years who participated in the survey from 2003–2016. We calculated up-to-date CRC screening uptake by colonoscopy, defined as colonoscopy within the last 10 years. To evaluate sociodemographic and medical predictors of colonoscopy use over four consecutive time periods, we entered age, sex, and any additional factors with P &lt; 0.10 on univariate analysis into a multivariable model and reached the final model for each period using stepwise backward selection. RESULTS: During the study period, 2,577 Chinese Americans were surveyed and 62.4% had received a colonoscopy within 10 years. On multivariable analysis, receiving a flu shot was the only consistent positive predictor of up-to-date colonoscopy use from 2009–2016 (OR 2.06–2.36, Table 1). Individuals without a primary care provider were less likely to have received a colonoscopy from 2003–2012 (OR 0.25–0.42), and the risk estimate remained consistent but was no longer statistically significant from 2015–2016. Similarly, being born outside of the US was associated with lower colonoscopy uptake from 2009–2014 (OR 0.06–0.22). Compared to never smokers, current but not former smokers were significantly less likely to have received up-to-date colonoscopy (OR 0.37 in 2003–2008; OR 0.16 in 2013–2014). Age, sex, borough of residence, and exercise activity were not consistent predictors of up-to-date colonoscopy uptake. CONCLUSION: Among Chinese Americans older than age 50 living in NYC, those who had a primary care provider and received annual flu shots were most likely to be up-to-date with colonoscopy. Foreign-born Chinese Americans and current smokers were less likely to have received colonoscopy. These findings highlight the importance of primary care for CRC prevention and provide insight into the vulnerable populations within the Chinese American community.

2834 Sex, Cancer Survivorship, and Colorectal Cancer Screening Among U.S. Adults: Analysis of a National Survey

INTRODUCTION: Men suffer higher burden from colorectal cancer (CRC) when compared to women. It is uncertain if this is due to poorer health services utilization or biological differences. It is well established that patients become more health conscious after a cancer diagnosis “as a wake-up call”. Aim: To determine uptake of CRC screening (with fecal occult blood test or endoscopy) among adult men and women in the United States and evaluate whether screening uptake differs by sex after a diagnosis of any cancer. METHODS: Methods: We used the 2013 Health Information National Trends Survey (HINTS) 4 cycle 3 conducted by the National Cancer Institute. A total of 1,829 respondents (weighted population size = 90,313,161) were 50 years and older. There were 732 (45.9%) men (weighted population size = 41,452,732) and 1,097 (54.1%) women (weighted population size = 48,860,429). There were 356 (14.7%) cancer survivors (weighted population size = 13,267,800) and 1,473 (85.3%) (weighted population size = 77,045,361) without any history of cancer. We evaluated whether survey respondents were ever screened for CRC (with fecal occult blood test or endoscopy) and compared CRC screening by cancer survivorship among men and women. All percentages were weighted. RESULTS: Overall, there were no sex differences in CRC screening rates among respondents (70.5% versus 75.2%; OR = 0.79; 95% CI: 0.58-1.07; P value = 0.13) regardless of cancer status. However, cancer survivors had increased CRC screening uptake (85.5% versus 70.5%: OR = 2.48; 95% CI: 1.46-4.22; P value = 0.001) regardless of sex in unadjusted analysis. Although there was an absolute 20.2% increase in CRC screening among men and an absolute 11.7% increase in CRC screening among women who have been diagnosed with a cancer, the differences were not statistically significant after adjustment for healthcare insurance status (Table 1). CONCLUSION: Conclusion: Increased efforts should be made to improve CRC prevention education and healthcare insurance coverage of US adults.

321 Factors Associated With Up-to-Date Colonoscopy Use Among Puerto Ricans in New York City, 2003-2016

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of cancer death among Hispanic Americans. Puerto Ricans are the second largest Hispanic subgroup in the United States and the largest in New York City, but little is known about predictors of CRC screening uptake in this population. We used the New York City Community Health Survey (NYCCHS), a population-based telephone survey, to investigate predictors of up-to-date colonoscopy use over time among Puerto Ricans aged ≥50 in NYC. METHODS: We assessed the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy in the last 10 years) over four time periods: 2003-2008, 2009-2012, 2013-2014, and 2015-2016. We entered age, sex, and any additional factors with P &lt; 0.10 on univariate analysis into a multivariable model and reached the final model for each period using stepwise backward selection. RESULTS: On univariate analysis, factors including age ≥65, having a primary care provider, and receiving the flu shot were associated with colonoscopy use in the last 10 years. After adjusting for multiple sociodemographic and medical factors (Table 1), age ≥65 [OR 1.41 (2003-2008), OR 1.76 (2013-2014), OR 1.82 (2015-2016)] and receiving the flu shot [OR 2.14 (2003-2008), OR 1.52 (2009-2012), OR 1.95 (2013-2014), OR 1.62 (2015-2016)] were two factors positively associated with up-to-date colonoscopy use over most time periods. Those without a primary care provider [OR 0.53 (2003-2008), OR 0.38 (2013-2014)] were significantly less likely to have an up-to-date colonoscopy. CONCLUSION: Older age, having a primary care provider, and receiving the flu shot are independent predictors of up-to-date colonoscopy use among Puerto Ricans in NYC. Targeted interventions to improve CRC screening should be considered for Puerto Ricans aged 50-64 and those who do not have a primary care provider.

331 Predictors of Colonoscopy Use Among Asian Indians in New York City, 2003-2016

INTRODUCTION: Asian Americans have the lowest colorectal cancer screening uptake of any racial/ethnic group in the United States. Among Asian Americans, Asian Indians appear to be particularly under-screened, although data for this population is limited. Our objective was to characterize temporal trends in predictors of up-to-date colonoscopy use among Asian Indians in New York City. METHODS: We analyzed data from Indian participants in the 2003-2016 New York City Community Health Survey (NYCCHS), an annual telephone-based health survey. A total of 496 participants aged 50 years or older were identified during the study period. We examined 4 consecutive time periods for factors associated with up-to-date colonoscopy use (defined as a colonoscopy within the last 10 years): 2003-2008, 2009-2012, 2013-2014, and 2015-2016. Age, sex, and any other variable with P &lt; 0.10 on univariate analysis was entered into a multivariable model; stepwise backward selection was performed to create the final model. RESULTS: On univariate analysis, factors associated with up-to-date colonoscopy use in at least two time periods included greater time in the US, non-Manhattan borough of residence, having received a flu shot, and age older than 65 years. Home language other than English, foreign birthplace, and not having a primary care provider were associated with decreased colonoscopy uptake. On multivariable analysis, older age, non-Manhattan borough of residence, BMI 25-29.9, higher income, and having received a flu shot were positively associated with colonoscopy use while Indian language, unemployment, and being non-diabetic were negatively associated in at least one time period. Compared to English, Indian home language was the most consistent negative predictor of colonoscopy uptake (OR 0.12-0.32 from 2003-2014). CONCLUSION: In a large study of Asian Indians in NYC, home language—a measure of acculturation—was the most consistent predictor of up-to-date colonoscopy use. Well-characterized predictors of screening in the general population, including education and insurance status, were not significant factors in the Indian population. These findings suggest targeted intervention for less acculturated members of the Asian Indian community may be warranted, and further research in this under-screened population is needed.

Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada.

BackgroundColorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population‐based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants.MethodsWe conducted a population‐based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50‐74 who were eligible for FOBT from 1 April 2013 to 31 March 2015.ResultsWe found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim‐majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90‐0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim‐majority countries.ConclusionsThese findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information.

Type 2 diabetes and colorectal cancer screening: Findings from the English Longitudinal Study of Ageing.

Type 2 diabetes has been identified as a risk factor for colorectal cancer, but little is known about whether it influences participation in colorectal cancer screening programmes. This study tested the extent to which Type 2 diabetes is negatively associated with colorectal cancer screening uptake. We analysed individual data of screening eligible men and women aged 60–75 without cancer diagnosis from wave 6 of the English Longitudinal Study of Ageing (collected 2012–2013), to investigate whether Type 2 Diabetes influences colorectal cancer screening behaviour independently of demographic characteristics, body mass index, socio-economic status and other chronic diseases. Individuals who reported to have Type 2 diabetes or had glycated haemoglobin (HbA1c) levels of 48 mmol/mol or higher were less likely to have ever completed a screening test (faecal occult blood test; 62.8% vs. 75.8%, p < 0.01) or to be up-to-date with their biennial screening invitation (60.2% vs. 72.0%, p < 0.05). The negative associations of Type 2 diabetes on colorectal cancer screening were found both in unadjusted and adjusted regression models. Future qualitative and quantitative research should identify reasons for this discrepancy, to inform interventions to increase screening uptake in this high-risk population.

Socio-cognitive determinants of colorectal cancer screening uptake: An application of intervention mapping approach.

Background: Fecal occult blood test (FOBT) is one of the common screening tests for colorectal cancer. This study was designed to determine the socio-cognitive determinants related to FOBT uptake for colorectal cancer screening based on intervention mapping (IM). Methods: A total of 500 individuals aged over 50 years were randomly selected to participate in this study in Kermanshah, Iran, in 2016. Data were collected by interviews based on a questionnaire and analyzed by SPSS16 using bivariate correlation, linear, and logistic regression models. Results: Of the 500 respondents, 468 (93.6%) signed the consent form and voluntarily participated in the study. Almost 11.1% of the participants had a history of FOBT uptake. Socio-cognitive variables accounted for 38% of the variation in the outcome measure of the intention to uptake FOBT. Perceived self-efficacy (OR = 3.345 & 95% CI: 1.342, 8.339), perceived susceptibility (OR = 2.204& 95% CI: 1.320, 3.680), attitude (OR = 1.674& 95% CI: 1.270, 2.137), and perceived severity (OR = 1.457& 95% CI: 0.954, 2.224) were the strongest predictors of fecal occult blood test uptake. Conclusion: IM-based analysis of behavior may provide insights to design interventions for modifying individuals’ beliefs about the usefulness of FOBT uptake to prevent colorectal cancer.