Colorectal Cancer Screening Research Articles

Abstract PR009: Gut microbiome differences across race, ethnicity, and area level deprivation among patients undergoing colorectal cancer screening in Federally Qualified Health Centers

Abstract Purpose: It is likely that social determinants of health influence the gut microbiome (GM). The GM is a rising risk factor for colorectal cancer (CRC), which disproportionately affects Black individuals and some Hispanic ethnic groups. We conducted a pilot investigation of the associations of race, ethnicity, and area level deprivation with the GM. Methods: We recruited adults receiving fecal immunochemical tests (FIT) for CRC screening at Federally Qualified Health Centers in a local Florida community setting. We manually extracted DNA from residual FIT stool among n=81 participants and conducted whole genome shotgun sequencing. Rarefied alpha (Observed ASVs and Shannon Index) and beta diversity (Bray Curtis distance) were calculated for species and genes. We estimated centered log ratio transformed taxonomic and functional profile relative abundances. We took an a priori approach, focused on bacteria and genes (e.g., those related to bile acids) that were previously associated with colorectal carcinogenesis. We estimated the percentage variation explained in beta diversity using multivariable PERMANOVA. Multivariable linear and zero-inflated quantile (ZINQ) regression models were used to estimate associations of race and ethnicity with microbial metrics. Results: In this pilot, n=54 (67%), n=18 (22%), and n=9 (11%) participants identified as Hispanic (H), Non-Hispanic White (NHW), and Non-Hispanic Black (NHB), respectively. The percentage variation in beta diversity explained by race/ethnicity was not statistically significant, but area level deprivation explained 3% (p=0.04) of Bray Curtis distance. Species alpha diversity was slightly lower among H individuals compared to NHW individuals (Shannon Index, β= -0.33, p=0.09). Several potentially pro-carcinogenic bacterial species and genera were more abundant among H compared to NHW individuals: Fusobacterium nucleatum (β = 0.54, pZINQ=0.01), Prevotella intermedia (β = 0.97, pZINQ=0.04), and Dialister (β = 1.69, pZINQ=0.14); Gemella morbillorum (β = 1.39, pZINQ=0.06) was more abundant in NHB compared to NHW participants. Several genes/pathways tended to be less abundant among H compared to NHW individuals, including those related to bacterial virulence [virB4 (β = -0.77, pZINQ=0.03)] and to butyrate synthesis pathways [atoB (β = -0.78, pZINQ=0.30)]. On the other hand, baiF, involved in secondary bile acid generation, was slightly more abundant among H compared to NHW participants (β = 0.23, pZINQ=0.17) while tyrB, involved in tyrosine and phenylalanine production, was slightly more abundant among NHB versus NHW individuals (β = 0.71, pZINQ=0.11). Conclusions: Several racial/ethnic differences in microbial metrics were identified. Importantly, microbiome metrics previously identified to promote colorectal carcinogenesis were more abundant in H and NHB compared to NHW individuals. Overall, our findings represent a promising first step to identifying GM-targeted intervention strategies (e.g., via diet) for effectively addressing CRC disparities. Citation Format: Stephanie Hogue, Maria F. Gomez, Jin Xu, Youngchul Kim, Rosa Veramendi, Martha Fuentes, Carolina Wetzler, Jessica Burns, Sugriva Forsyth, Rania Abdulla, Cathy Meade, Clement Gwede, Doratha A. Byrd. Gut microbiome differences across race, ethnicity, and area level deprivation among patients undergoing colorectal cancer screening in Federally Qualified Health Centers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR009.

Abstract A167: Use of a culturally adapted version of the Colorectal Cancer Screening Intervention Program (CCSIP) on Black immigrants in Salt Lake City

Abstract Background: Colorectal Cancer (CRC) disproportionately affects Blacks in the United States (US) with an incidence rate >20% compared with Whites. Genetic factors are believed to contribute as much as 35% to the overall risk of CRC. Recent male immigrants from Africa aged 45 and above may be at increased risk of developing the disease. Previous studies have reported cultural barriers in the uptake of CRC screening services in adult black immigrant populations. Therefore, providing culturally adapted versions of preventive services may be critical in reducing the disparities in cancer morbidity and mortality. The study therefore sought to evaluate the feasibility of adopting a culturally tailored CRC prevention intervention program to improve uptake among immigrants. Methods: We used the Delphi methodology to recruit a seven-man team of leaders in the African immigrant community exploring their views by administration of open-ended questions. The methodology was based on the Conducting and REporting of DElphi studies (CREDES) methodology with participants queried over three rounds about the appropriateness of a culturally adapted version of the Colorectal Cancer Screening Intervention Program (CCSIP) protocol of the National Institutes of Health (NIH). Participants also considered and gave anonymous feedback on what they perceived to be the strengths of responses of others and the findings of bigger group. This framework of expert opinion rounds was used to build the final consensus opinion. Results: There was critical consensus on the appropriateness of building trust-enhancing, fear and fatalism-reducing messages into the CCSIP protocol. There was weaker agreement on the need for religiously tailored messages. Conclusion: Improving the quality of the CCSIP protocol may be important in future interventions targeted at increasing CRC screening uptake among African immigrants. Citation Format: Olanrewaju O. Onigbogi, Kebba Kah, Kolawole Okuyemi. Use of a culturally adapted version of the Colorectal Cancer Screening Intervention Program (CCSIP) on Black immigrants in Salt Lake City [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A167.

Abstract B085: Promoting colorectal cancer screening among underserved Vietnamese Americans through a multilevel community-based randomized controlled trial

Abstract Introduction: Early detection through routine screening is also necessary to improve the mortality rate of colorectal cancer (CRC). However, testing is up to date in only 63% of eligible adults, and rates are lower among minority race/ethnicity groups and the underinsured. Fecal immunochemical test (FIT) is non-invasive, home-based screening kit that has been an important and cost-effective option in resource-limited settings. Vietnamese Americans were disproportionally affected by CRC, yet screening rates in this population were suboptimal. Reducing this disparity requires efforts to address upstream factors such as systemic discrimination, sociocultural norms, interpersonal factors, in addition to individual-level barriers to CRC care. Methods: From 2017 to 2020, we conducted a large-scale community-based randomized controlled trial of a culturally appropriate multilevel intervention to increase colorectal cancer (CRC) screening among 801 underserved Vietnamese Americans aged 50 or older from 20 community-based organizations (CBOs) in the greater Philadelphia metropolitan area. Specifically, the intervention is conducted at three levels: (1) individual-level: education through group workshops and other medium, automated text messaging reminders, as well as patient navigation; (2) interpersonal-level: engagement of participants’ families and friends; (3) CBO-level: CBO leaders engagement and promotion of CRC screening, displaying CRC screening promotion poster at CBO facility, and organizational role improvement. Results: The study sample consist of 801 eligible Vietnamese American participants, among whom, 746 completed the 12-month follow-up survey. Most (95%) of the participants had limited English proficiency. Analyses of baseline data revealed links between CRC screening uptake and several contextual and environmental factors, including neighborhood Asian ethnic density, social deprivation, and built environment, indicating systemic and community-level barriers to CRC care. Our multilevel intervention was effective in promoting the uptake of CRC screening in the target population. At 12-month follow-up, participants from the intervention group had significantly higher rates of having had a FIT test than those in the control group (89.56% v 7.59%, p < .001) or any CRC test (91.48% vs 42.41%, p < .001). Furthermore, the intervention was effective in increasing CRC-screening related self-efficacy, de-stigmatizing CRC and CRC screening and improving social norm among participants in the intervention arm. Conclusion: In conclusion, by improving social norms and elevation CBO/community engagement in relation to CRC care, our project significantly improved CRC screening uptake among Vietnamese Americans. Implementing community-based strategies like partnering with relevant community- based organizations are important for meeting CRC screening targets. Citation Format: Grace X Ma, Lin Zhu, Yin Tan, Phuong Do, Guercie Guerrier, Min Qi Wang, Minhhuyen T Nguyen, Tam Tran, Philip Pham. Promoting colorectal cancer screening among underserved Vietnamese Americans through a multilevel community-based randomized controlled trial [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B085.

Abstract A073: Gut microbiome differences across race, ethnicity, and area level deprivation among patients undergoing colorectal cancer screening in Federally Qualified Health Centers

Abstract This abstract is being presented as a short talk in the scientific program. A full abstract is printed in the Proffered Abstracts section (PR009) of the Conference Program/Proceedings. Citation Format: Stephanie Hogue, Maria F. Gomez, Jin Xu, Youngchul Kim, Rosa Veramendi, Martha Fuentes, Carolina Wetzler, Jessica Burns, Sugriva Forsyth, Rania Abdulla, Cathy Meade, Clement Gwede, Doratha A. Byrd. Gut microbiome differences across race, ethnicity, and area level deprivation among patients undergoing colorectal cancer screening in Federally Qualified Health Centers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A073.

Voluntary private health insurance and cancer screening utilisation in Europe.

Cancer is a leading cause of death in Europe and prevention measures, like screening, are therefore becoming increasingly important. Although European countries provide universal health coverage, including cancer screenings, many people also have private health insurance. The aim of this study is to analyse the relationship between Voluntary private health insurance (VPHI) and cancer screening, specifically breast and colorectal cancer screening. Using data from SHARE, the Survey of Health, Ageing and Retirement in Europe, different logistic and multilevel regressions were estimated. The major finding shows a positive correlation between people being screened for cancer and having VPHI. Three conclusions can be drawn: advantageous selection may exist in private health insurance; spillover effects may exist from the public sector into the private sector, which in turn may result in a lower insurance premium; and there may be a perpetuation of inequalities in health service utilisation. Several policy implications can be drawn from this result, but the most relevant concerns narrowing the inequities that could potentially arise between those who have private health insurance and those who do not.

Colorectal cancer care continuum: Navigating screening, treatment, and outcomes disparities.

This review investigates the disparities in colorectal cancer screening, treatment, and outcomes among different racial, ethnic, socioeconomic, and geographic groups. Although there has been progress, notable disparities continue to exist as a result of socioeconomic status, access to healthcare, and systemic prejudices. Approaches to tackle these challenges involve expanding screening access, enhancing healthcare utilization, addressing socioeconomic obstacles, ensuring fair treatment, and boosting representation in research.

Dataset-level color augmentation and multi-scale exploration methods for polyp segmentation

Automatic segmentation of polyps from colonoscopy images plays a critical role in early screening and treatment of colorectal cancer. Although deep learning methods have made significant progress, precise polyp segmentation faces two challenges: (1) the imbalance of color appearances in the limited training dataset hinders the generalization of the model, and (2) polyps have the diverse scales, locations and shapes with blurred boundary. To address the issues, Dataset-Level Color Augmentation (DLCA) and Convolutional Multi-scale Attention Module (CMAM) are proposed. DLCA employs the dataset-level color knowledge and generate new color appearances, to avoid the model learning false associations with colors. Meanwhile, CMAM simultaneously explores the region and boundary clues and model multi-scale context, which improves the accuracy of polyp localization and fine-grained segmentation. We conduct comprehensive experiments and compare our network with state-of-the-art methods. The proposed model is superior on multiple polyp datasets, especially on ETIS, where mDice and mIoU reach 0.839 and 0.766. Furthermore, it is validated that DLCA can be widely applied to most polyp segmentation methods, and CMAM is practical and plug-and-play. Finally, the model demonstrates promising generalization to breast ultrasound and skin lesion segmentation.

Colorectal cancer in older adults after the USPSTF’s 2008 updated screening recommendation

BackgroundColorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults. MethodsWe obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74). ResultsThere was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+. DiscussionThe USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.

Organizational features of detection of secondary metachronic primary multiple colorectal cancer in a group of patients with extracolorectal malignancies

Aim – to study the organizational features of detection of secondary metachronous primary multiple CRC in patients with primary extracolorectal malignancies. Material and methods. The medical documentation of 163 oncological patients with extracolorectal malignancies and secondary metachronous CRC was analyzed. The patients were divided into subgroups according to the profile of dispensary observation. Results. In 66% (108) of cases, patients were diagnosed with malignancies of four subgroups: skin, breast, urological and gynecological spheres, the number of cases of malignancies’ localization correlated with the number of accumulated contingent. CRC at stage 1 was detected in 24% of cases. The right parts of the colon were affected in 22.1% (36) of cases, the left – in 38.7% (63), the rectum – in 33.1% (54), tumors of several departments – in 4.9% (8), anal cancer – in 1.2% (2) of cases. CRC was detected in the period from 7 to 678 months after extracolorectal malignancies. Earlier, CRC was diagnosed in cases with skin and urological tumors, later, in the group with breast cancer and oncogynecological profile. Conclusion. The majority of the subjects were women (60.7%), the average age was 69 years. Patients with oncodermatological (22%), oncourological (15.3%), oncomammological (15.3%), oncogynecological (13.5%) profiles, lesions of the left colon (38.7%) and rectum (33.1%) predominated. The time interval between the detection of the primary tumor and the detection of secondary CRC depends on the localization of the primary malignancies (p=0).Screening of CRC is necessary not only among the healthy population, but also in the group of patients with extracolorectal malignancies, it is possible to use an immunochemical quantitative stool test for hidden blood at the stage of providing specialized medical care in the "oncology" profile.

The association between food insecurity and colorectal cancer screening: 2018-2021 New York State Behavioral Risk Factor Surveillance System (BRFSS).

To assess the association between food insecurity and colorectal cancer screening uptake in screening eligible participants in New York State. We analyzed 28,154 adults who participated in New York State Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2021, were age-eligible for colorectal cancer screening based on the USPSTF guidelines at the time of survey administration and answered a version of the administered survey that included the module on food insecurity. Participants were defined as food insecure if they self-reported being always, usually, or sometimesstressed about having enough money to buy nutritious meals in the past 12months. We compared demographic, healthcare access, overall health status, food insecurity by colorectal cancer screening status. Multivariable analyses were performed to assess the association of food insecurity and colorectal cancer screening status after adjusting for relevant covariates. Weighted analyses were performed using survey procedures to obtain population estimates. Food insecurity was statistically significantly associated a decreased likelihood of being up to date on colorectal cancer screening (ORadj 0.83, 95% CI [0.72, 0.94]) and being ever screened for colorectalcancer (ORadj 0.74, 95% CI [0.64, 0.87]) after adjusting for overall health status, healthcare coverage, interview year, age, race/ethnicity, sex, educational attainment, and income. Health status, health coverage, age, and Non-Hispanic Black race/ethnicity showed positive, statistically significant association with ever being screened and with being up to date for colorectal cancer screening. Lower income, lower educational attainment, and non-Hispanic Asian race/ethnicitywere statistically significant inverse predictors of ever being screened and being up to date on screening. This project assessed the association between food insecurity and colorectal cancer screening uptake using the BRFSS survey. Food insecurity may be an important predictor for colorectal cancer screening uptake in eligible adults in the United States. The results from the study can inform future interventions and policies designedto improve participation inroutinecolorectal cancer screening.

Association between the uptake rates of countermeasure-type colorectal cancer screening, new cancer detection indices, and number of municipal public health nurses: An ecological study

Objective We conducted an ecological analysis of the structures and processes of municipalities implementing countermeasure-type colorectal cancer screening services, which are associated with high mortality and morbidity rates. We analyzed the populations' demographic characteristics, number of public health nurses (PHNs), and human base for such services. The process was evaluated using the screening uptake rates for countermeasure-type cancer screening and detection indices.Methods The data included municipal population figures, areas, and national health insurance enrolments, all sourced from a government statistics portal (e-Stat). We obtained the number of PHNs per 100,000 population from PHN activity area surveys, information on municipal colorectal cancer screening from public health centers (PHCs) and health promotion project reports, and cancer detection indices from the National Cancer Registry data. The analysis covered 1,234 municipalities with populations of ≥10,000 and ≥50,000, categorized into three groups based on the presence of PHCs. The internal structures were compared using multiple regression analysis.Results The number of PHNs per 100,000 population was categorized as follows; <50,000 population group (42.9), ≥50,000 population group (24.3), and PHC-present city group (16.4).Among these groups, the mass and individual screening rates were 96.2% and 47.7%, 69.1% and 91.5%, and 83.7% and 69.9%, respectively. The average uptake rates of countermeasure-type screenings and detailed examinations were 10.6-13.7% and 68.4-75.3%, respectively. In both cases, the <50,000 population and PHC-present city groups exhibited high and low values, respectively. However, the proportion of patients with "early cancer" detection was approximately 42% in all groups.Multiple regression analysis, using the countermeasure-type screening uptake rate and colorectal cancer detection indices as dependent variables, revealed that in the <50,000 population group, in which mass screening was prevalent, the number of PHNs was significantly positively correlated with the countermeasure-type screening uptake rate and proportion of "new cancers" detected by screening.Contrastingly, the PHC-present city group showed no correlation between the number of PHNs and countermeasure-type screening uptake rate, but a highly detailed examination uptake rate was significantly positively correlated with the proportion of "early cancer" detection.Conclusion In municipalities without PHCs, countermeasure-type screening uptake rates, particularly mass screening rates, were positively correlated with the number of PHNs and cancer detection indices. In cities with PHCs, in which individual screening was prevalent, the detailed examination uptake rate through countermeasure-type screening was correlated with detection indices.

Pooling controls from nested case-control studies with the proportional risks model.

The standard approach to regression modeling for cause-specific hazards with prospective competing risks data specifies separate models for each failure type. An alternative proposed by Lunn and McNeil (1995) assumes the cause-specific hazards are proportional across causes. This may be more efficient than the standard approach, and allows the comparison of covariate effects across causes. In this paper, we extend Lunn and McNeil (1995) to nested case-control studies, accommodating scenarios with additional matching and non-proportionality. We also consider the case where data for different causes are obtained from different studies conducted in the same cohort. It is demonstrated that while only modest gains in efficiency are possible in full cohort analyses, substantial gains may be attained in nested case-control analyses for failure types that are relatively rare. Extensive simulation studies are conducted and real data analyses are provided using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) study.

Evidence from an Applied Health Research Question: Health Equity Profiles of Community Health Centre (CHC) and non-CHC clients

Objective/ApproachThe Black Health Equity Working Group's Applied Health Research Question aimed to compare cancer screening rates and surgical wait times between community health centre (CHC) clients based on race-related data and non-CHC clients. CHC client data was categorized by self-identified racial groups, with Black self-identification compared to non-Black racialized, White, and missing racial self-identification, and non-CHC clients. Health card numbers were encrypted to link individuals to the Primary Care Population dataset for breast, cervical, and colorectal cancer screening rates. Surgical wait time indicators, such as the number of patients undergoing surgery and average wait times for initial consultation and completed surgeries, were derived from the Wait Time Information System. Assessments were conducted semi-annually from fiscal year 2018 to 2021. ResultsFollowing the onset of COVID-19, CHC clients self-identifying as Black experienced the most significant decrease (6.8%) in colorectal screenings compared to other groups. Mammogram screenings remained consistently higher for CHC clients self-identifying as Black pre- and post-pandemic. Average cervical cancer screening rates were approximately 8% higher among CHC clients compared to non-CHC clients, irrespective of racial self-identification. However, due to small sample sizes and missing data among self-identified racial groups, trends in surgical wait times for both CHC and non-CHC clients were unstable. Conclusion/ImplicationsTailored interventions targeting Black CHC clients can enhance cancer screening rates, particularly colorectal screenings. The analysis of CHC data offers valuable insights into race-based disparities in health outcomes. Improved data completeness is essential for accurately assessing health outcome variations among different racial groups.

SP3.12 - Effect of Anticoagulants on Faecal Immunochemical Tests (FITs) in Bowel Cancer Screening

Abstract Background Bowel cancer screening in the United Kingdom is based on the faecal immunochemical test (FIT). Eligible participants sometimes use anticoagulants which may stimulate bleeding from benign lesions affecting the screening performance of FITs for colorectal cancer. We aimed to evaluate the effectiveness of FITs in screening for colorectal cancer for patients taking anticoagulants. Methods This was a retrospective study of FIT positive patients on anticoagulation who underwent colonoscopy or CT colonoscopy between October 2022 and June 2023. The threshold for a FIT positive result was 150µg Hb/g of faeces for asymptomatic patients and 10µg Hb/g of faeces for symptomatic patients. Histology reports were reviewed for the presence of colorectal neoplasms and advanced adenomas (defined as adenomas with high-grade dysplasia, villous histology, or ≥10mm in size). Results A total of 57 patients were included- 38 used a direct oral anticoagulant (DOAC), 3 used warfarin, 15 used clopidogrel or ticagrelor, and 1 used dabigatran. Colorectal cancer was identified in 8.8% of individuals (5 out of 57) and advanced adenoma in 17.5% of individuals (10 out of 57). Use of anticoagulants was associated with a positive predictive value for advanced neoplasia (PPVAN) of 26.3%. Conclusion FIT accuracy as a surrogate marker for advanced neoplasia was not affected by the use of anticoagulants when compared with the current literature. Suspension of anticoagulation prior to FIT screening is not recommended. Further studies investigating the dosage and class of anticoagulation on FIT accuracy for bowel cancer screening may be warranted.

Cancer Screening, Knowledge, and Fatalism among Chinese, Korean, and South Asian Residents of New York City.

Asian New York City residents have the lowest cancer screening uptake across race and ethnicity. Few studies have examined screening differences across Asian ethnic subgroups in New York City. Cross-sectional survey data were analyzed using multivariable logistic and multinomial regression analyses. Differences among Chinese, Korean, and South Asian adults in breast, cervical, and colorectal cancer screening uptake; breast and colorectal cancer screening knowledge; and cancer fatalism were examined. Associations between breast and colorectal cancer screening knowledge and their uptake were also assessed along with associations between cancer fatalism and breast, cervical, and colorectal cancer screening uptake. Korean women reported 0.52 times [95% confidence interval (CI), 0.31-0.89] lower odds of Pap test uptake compared with Chinese women; South Asian adults had 0.43 times (95% CI, 0.24-0.79) lower odds of colorectal cancer screening uptake compared with Chinese adults. Korean adults reported 1.80 times (95% CI, 1.26-2.58) higher odds of knowing the correct age to begin having mammograms compared with Chinese adults; South Asian adults had 0.67 times (95% CI, 0.47-0.96) lower odds of knowing the correct age to begin colorectal cancer screening compared with Chinese adults. Korean adults had 0.37 times (95% CI, 0.27-0.53) lower odds of reporting cancer fatalism compared with Chinese adults. Low cancer screening uptake among Asian American adults, low screening knowledge, and high cancer fatalism were found. Cancer screening uptake, knowledge, and fatalism varied by ethnic subgroup. Findings indicate the need for ethnicity-specific cultural and linguistic tailoring for future cancer screening interventions.

Comparative Effectiveness of Decision Aids for Cancer-Screening Decision Making: An Overview of Reviews.

Decision aids (DAs), compared to no DAs, help improve the key aspects of shared decision-making, including increased knowledge, discussion frequency, and reduction in decisional conflict. However, systematic reviews have reported varied conclusions on screening uptake, and which DAs are superior to alternative forms in shared decision-making for cancer screening has not been comprehensively reviewed. An overview of systematic reviews was performed. Multiple databases were searched up to December 31, 2023, for systematic reviews of randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) of any size that assessed a decision aid aimed to facilitate cancer-screening decision making communications. Dual screening of abstracts and full-text reports, dual data extraction and quality assessment, and qualitative synthesis were performed. The 22 eligible publications included 24 reviews on cancer screening DAs for a single specific cancer (8, 8, 7, and 1 on prostate, breast, colorectal, and lung cancer, respectively) and three reviews on multiple aggregate cancers. Individual reviews were based on different primary study designs (92 RCTs and 37 NRCSs); each study was infrequently cited (median citation count 2; range 1-9). Although the DAs had variable formats and delivery methods, the reviews generally focused on use and non-use comparisons. DAs decreased the intention or actual uptake for prostate and breast cancer screening, but increased it for colorectal cancer screening. DAs were associated with increased knowledge, well-informed choice, and reduced decisional conflict, regardless of cancer type. Only four reviews on comparative effectiveness between alternative formats of DAs (based on 14 RCTs and 2 NRCSs) failed to conclude on the specific format that was superior to others. DAs improve cancer screening shared decision-making by boosting cancer screening knowledge and informed choice and lowering decisional conflict and may facilitate preference-based, individualized screening participation. Comparative data on different cancer screening DAs are limited. PROSPERO, CRD42021235957.

Comparative Performance of Common Fecal Immunochemical Tests : A Cross-Sectional Study.

Despite widespread use of fecal immunochemical tests (FITs) for colorectal cancer (CRC) screening, data to guide test selection are limited. To compare the performance characteristics of 5 commonly used FITs, using colonoscopy as the reference standard. Cross-sectional study. (ClinicalTrials.gov: NCT03264898). Three U.S. academic medical centers and affiliated endoscopy units. Patients aged 50 to 85 years undergoing screening or surveillance colonoscopy. Participants completed 5 different FITs before their colonoscopy, including 4 qualitative tests (Hemoccult ICT, Hemosure iFOB, OC-Light S FIT, QuickVue iFOB) and 1 quantitative test (OC-Auto FIT, which was run at the manufacturer's threshold for positivity of >100 ng/mL). The primary outcome was test performance (sensitivity and specificity) for each of the 5 FITs for advanced colorectal neoplasia (ACN), defined as advanced polyps or CRC. Positivity rates, positive and negative predictive values, and rates of unevaluable tests were compared. Multivariable models were used to identify factors affecting sensitivity. A total of 3761 participants were enrolled, with a mean age of 62.1 years (SD, 7.8); 63.2% of participants were female, 5.7% were Black, 86.4% were White, and 28.7% were Hispanic. There were 320 participants with ACN (8.5%), including 9 with CRC (0.2%). The test positivity rate varied 4-fold (3.9% to 16.4%) across FITs. Rates of unevaluable FITs ranged from 0.2% to 2.5%. The sensitivity for ACN varied from 10.1% to 36.7%, and specificity varied from 85.5% to 96.6%. Differences in sensitivity between FITs were all statistically significantly different except between Hemosure iFOB and QuickVue iFOB, and specificity differences were all statistically significantly different from one another. In addition to FIT brand, distal location of ACN was also associated with higher FIT sensitivity. The study did not assess the programmatic sensitivity of annual FIT. Although considered a single class, FITs have varying test performance for detecting ACN and should not be considered interchangeable. National Institutes of Health.

Applying cognitive walkthrough methodology to improve the usability of an equity-focused implementation strategy

BackgroundOur research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention.MethodsWe applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions.ResultsUsability ratings (scale 0–100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from “marginal acceptability” to “acceptable”. Ten usability problems were identified across four PEDDI tasks, comprised of 2–3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations.ConclusionsUsability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings.

New methods for colorectal cancer screening

New methods for colorectal cancer screening

Clinicopathological and molecular differences between stage IV screen-detected and interval colorectal cancers in the Flemish screening program.

Interval cancer (IC) is an important quality indicator in colorectal cancer (CRC) screening. Previously, we found that fecal immunochemical test (FIT) ICs are more common in women, older age, right-sided tumors, and advanced stage. Here, we extended our existing stage IV patient cohort with clinicopathological and molecular characteristics, to identify factors associated with FIT-IC. Logistic regression models were fit to identify variables associated with the odds of having a stage IV FIT-IC. Multivariate models were corrected for gender, age, and location. A total of 292 screen-detected (SD) CRCs and 215 FIT-IC CRCs were included. FIT-IC CRC had 5 fold higher odds to be a neuroendocrine (NET) tumor and 2.5 fold higher odds to have lymphovascular invasion. Interestingly, some variables lost significance upon accounting for location. Thus, tumor location is a critical covariate that should always be included when evaluating factors related to FIT-IC. We identified NETs and lymphovascular invasion as factors associated with increased odds of having a stage IV FIT-IC. Moreover, we highlight the importance of tumor location as a covariate in evaluating FIT-IC related factors. More research across all stages is needed to clarify how these insights might help to optimize the Flemish CRC screening program.