Colorectal Cancer Testing Research Articles

Abstract B009: ¡Salud!, por la Vida, an educational intervention to increase colorectal cancer screening in Puerto Ricans

Abstract From 2010-2014, colorectal cancer (CRC) was the second highest incident cancer and leading cause of cancer-related deaths in Puerto Rico (PR). Although preventable through screening and treatment, colorectal cancer screening (CRCS) using fecal occult blood test (FOBT) or colonoscopy remains low for adults in PR. Data from the 2016 Behavioral Risk Factor Surveillance System indicated that 18.0% of the PR population aged 50 to 75 had undergone an FOBT within the past year compared to 8.0% in the United States (US). Additionally, 50.1% of age-eligible Puerto Ricans report ever having a colonoscopy in the past 10 years compared to 63.5% in the US. Given the higher burden of CRC and the low CRCS rates in PR, we developed ¡Salud!, por la Vida (SPLV), an educational program which aims to increase CRCS in non-adherent men and women aged 50 and 75 who attend Federally Qualified Health Clinics (FQHCs) in PR. We used Intervention Mapping (IM) as framework to develop an educational intervention that is theoretically sound and grounded in evidence. For the development of SPLV, steps 1 to 4 of IM were completed. Step 1: a needs assessment conducted through focus groups and key informant interviews to gather quantitative and qualitative data for the development of the logic model and the program; step 2: development of a logic model of change and matrices of change objectives; step 3: selection of theory and evidence-based methods and strategies; and step 4: program production, components, and materials. Step 1 revealed 5 main themes: (1) lack of knowledge about CRC and CRCS practices; (2) patient’s fear of the CRC test results; (3) low risk perception of CRC; (4) lack of provider CRCS recommendation; and (5) the importance of social support. Interviews revealed that the majority of clinics offer FOBT as part of their CRCS protocol; where 74.0% of these had a clinical laboratory on-site. Over half (53.0%) had implemented electronic medical records and 82.0% had health educators on staff. A logic model was developed by combining personal behaviors with behavioral determinants and identifying beliefs targeted by the intervention (step 2). Tailored interactive multimedia intervention (TIMI) and small media were selected as the practical application to deliver the intervention (step 3). Development of the program included 5 components: script development; testimonials; animations; written materials; and newsletter. Pre-testing was conducted to evaluate the usability of the program. Our educational program, SPLV, is completed and currently being implemented, using a randomized trial. Trial is being conducted in 10 FQHCs and will recruit 710 participants aged 50 to 75 who have no prior history of CRC and are not adherent to CRCS guidelines. Clinics are randomized to either the intervention group (TIMI) or the control group (usual care). We aim that this intervention will significantly increase CRCS rates and provide evidence to disseminate this educational effort to FQHCs in PR. Citation Format: Vivian Colón-López, Camille Vélez-Alamo, Adrianna Acevedo-Fontanez, Marievelisse Soto-Salgado, Jorge L Rodríguez-Lebrón, Josheili Y Llavona-Ortiz, Yolanda Serra-Martínez, Ileska Valencia-Torres, María Fernández. ¡Salud!, por la Vida, an educational intervention to increase colorectal cancer screening in Puerto Ricans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B009.

Genotype and phenotype correlation of common cancer predisposition syndromes in sarcoma cases.

1524 Background: Sarcomas are rare heterogenous cancers affecting a predominantly younger population. The most recognised autosomal dominant contributor being pathogenic TP53 variants associated with Li Fraumeni Syndrome (LFS). When referred, patient eligibility for germline TP53 testing is assessed using classic or Chompret LFS criteria. Other heritable cancer syndromes which can be associated with sarcoma (breast/ovarian, colorectal) are more commonly considered in clinical practice. In some centres germline testing is offered to only those who meet established clinical criteria. Heritable cancer predisposition has several implications including therapy and clinical risk management. Here we report the concordance between clinical criteria and genotypes in sarcoma families. Methods: We included 1,664 sarcoma probands from the International Sarcoma Kindred Study. Eligibility for genetic testing was assessed using internationally accepted clinical criteria for recognised cancer syndromes. Whole genome sequencing was performed on peripheral blood DNA and variants in the ACMG cancer gene list were classified as pathogenic or likely pathogenic using established bioinformatics pipelines. Results: The median age of sarcoma diagnosis in 1664 probands (798 males, 866 Females) was 48 years (range 1-93). The median age of first cancer diagnosis was 46.5 years (0-93) with 291 probands having multiple primary cancers. Of 1504 informative pedigrees, 243 (16%) met criteria for testing; 207 (14%) TP53; 19 (1%) BRCA1/2; 2 (<1%) colorectal cancer (CRC) genes and 15 (1%) familial melanoma. Of 12 TP53 PVs identified, 9 met TP53 testing criteria. Of 13 PVs identified in HR genes (7 BRCA2, 4 PALB2 and 2 BRCA1) only 1 ( PALB2) met BRCA1/2 testing criteria and 2 met Chompret criteria. Both BRCA1 cases were male with a 1st degree relative with ovarian cancer. In CRC genes (1 APC, 2 MSH2, 4 MSH6, 1 PMS2), none met CRC testing criteria but 4 met Chompret criteria. No CDKN2A PVs were identified in melanoma families. Conclusions: In probands with sarcoma, clinical criteria for eligibility for testing for common non-LFS heritable syndromes perform poorly. This should be considered when making decisions regarding germline testing.

Association between colorectal cancer testing and insurance type: Evidence from the Swiss Health Interview Survey 2012.

Both colonoscopy and fecal occult blood test (FOBT) are commonly used for colorectal cancer (CRC) screening, but colonoscopy costs much more than FOBT. Swiss insurance offers high or low deductibles and choice of basic or private insurance. We hypothesized that high deductibles and basic insurance discourage colonoscopy, but do not change FOBT rates. We determined the proportion of patients tested for CRC in Switzerland (colonoscopy within 10years, FOBT within 2years), and determined associations with health insurance type. We extracted data on 50-75-year-olds from the Swiss Health Interview Surveys of 2012 to determine colonoscopy and FOBT testing rates (n=7335). Multivariate logistic regression models estimated prevalence ratios (PRs) of CRC testing associated with health insurance type (deductible and private insurance), adjusted for socio-demographic factors (age, gender, education, income) and self-rated health. The weighted proportion of individuals tested for CRC within recommended intervals was 39.5%. Testing with colonoscopy was significantly associated with private insurance (PR 1.85, 95% CI: 1.46-2.35) and low deductible (PR 2.00, 95% CI: 1.56-2.57). Testing with FOBT was significantly associated with deductible (PR 1.71, 95%CI:1.09-2.68) but not with private insurance. About 60% of the Swiss population was not current with CRC testing. After adjusting for covariates, private insurance and low deductible was significantly associated with higher prevalence of CRC testing, indicating that waiving the deductible could increase CRC screening uptake and reduce health inequality.

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.

5-Fluorouracil as a Tumor-Treating Field-Sensitizer in Colon Cancer Therapy.

Colorectal cancer (CRC) is a major cause of mortality that can be treated effectively with chemotherapy and radiotherapy, although resistance to these therapeutic modalities often occurs. Tumor-treating fields (TTFields) can block tumor growth by selectively impairing tumor cell division. In this study, we investigated the mechanism by which 5-fluorouracil (5-FU) sensitizes tumor cells to TTFields. Human HCT116 and SW480 CRC cells were treated with 5-FU and/or TTFields, and characterized in vitro in terms of cell viability, apoptosis through reactive oxygen species production, autophagy, and metastatic potentials. The biological effects of 5-FU and/or TTFields were studied via positron emission tomography and computed tomography on xenograft tumor growth and were confirmed with organoid models of patients. Our results revealed that combination treatment with 5-FU and TTFields increased the efficiency of TTFields therapy in colon cancer cells by downregulating signaling pathways associated with cell proliferation, survival, cell invasion, and migration while upregulating pathways mediating apoptosis and autophagic cell death. The novel mechanistic insights gleaned in this study suggest that combination therapy with TTFields and 5-FU may be effective in treating CRC, although safety and efficacy testing in patients with CRC will need to be performed before this strategy can be implemented clinically for TTF-sensitization.

Incorporating Colorectal Cancer Genetic Risk Assessment into Gastroenterology Practice.

Decades have passed since the underlying molecular etiologies of the most common hereditary forms of colorectal cancer (CRC), Lynch syndrome, and familial adenomatous polyposis (FAP) were first described. With the advent of next-generation sequencing (NGS) panels, the landscape of hereditary CRC testing has changed dramatically. We review available screening strategies, novel CRC predisposition genes, and challenges and opportunities in this field. Improved sensitivity and availability of NGS panel testing have greatly expanded our understanding regarding the number of CRC syndromes and their phenotypic expression. A variety of screening strategies are available to identify heritable CRC syndromes, potentially decreasing morbidity and mortality in this population. However, these screening strategies remain imperfect and present challenges regarding their implementation in clinical practice. Screening strategies include universal screening of CRC tumors for Lynch syndrome, clinical prediction algorithms, and risk assessment questionnaires. Additionally, there remains a gap in our understanding of the clinical implications of novel gene mutations of variable penetrance and unexpected NGS panel test results. Incorporation of single nucleotide polymorphisms (SNPs) may help to further refine cancer risk assessment, and the clinical introduction of RNA analysis may allow us to clarify variants of unknown significance (VUSs) and identify deep intronic mutations that would otherwise be missed. Recognition of genetic predisposition to CRC is critical for the practicing gastroenterologist. The evolving field of cancer genetics offers great challenges and opportunities for improved CRC management.

External Validation of a Colorectal Cancer Model Against Screening Trial Long-Term Follow-Up Data

BackgroundThe University of Sheffield School of Health and Related Research (ScHARR) Bowel Cancer Screening Model has been used previously to make decisions about colorectal cancer screening strategies in England. ObjectivesThe objective of this study was to perform an external validation of the ScHARR model against long-term follow-up data about colorectal cancer (CRC) incidence and mortality reductions due to screening, from the Nottingham trial of guaiac faecal occult blood testing for CRC, and the UK Flexible Sigmoidoscopy Screening Trial. MethodsThe ScHARR model was adapted prior to validation to reflect the setting of each trial in terms of population characteristics, details of screening and surveillance programs, uptake of screening, and further investigations and study follow-up. The impact of using current versus historical CRC incidence and mortality data in the validation was also examined by carrying out a series of analyses in which historical data from different years was included in the model. ResultsThe ScHARR model was able to predict CRC incidence and mortality rate/hazard ratios from both trials to well within the 95% confidence intervals in the observed data. While it was less accurate in predicting absolute incidence and mortality rates, modeling historical incidence and mortality data enabled these predictions to be improved considerably. ConclusionThe ScHARR model is able to replicate the long-term relative benefit from screening observed in 2 large-scale UK-based screening trials and can therefore be considered to be an appropriate tool to facilitate decision making around the English bowel cancer screening program.

Variation in colorectal cancer testing between primary care physicians: a cross-sectional study in Switzerland.

To determine the proportion of 50-75-year-old patients who visit a primary care physician's (PCP) office and were tested for colorectal cancer (CRC) by either colonoscopy within 10years or fecal occult blood testing (FOBT) within 2years. To describe the variation in care between PCPs and factors associated with these proportions. Cross-sectional data collected between April and December 2017. PCPs reporting for the Swiss Sentinel Surveillance Network. Each PCP collected demographic data and CRC testing status from 40 consecutive patients. proportions of patients up to date with CRC screening and method used (colonoscopy/FOBT/Other); variation in the outcome measures between PCPs; association of physician-level factors with main outcomes. 91/129 PCPs collected data from 3451 patients; 45% had been tested for CRC within recommended intervals (41% colonoscopy, 4% FOBT). The proportions of patients tested and testing with colonoscopy versus FOBT varied widely between PCPs. Language region was associated with PCPs' rate of FOBT prescription. Less than half of patients who visited PCPs in Switzerland were tested for CRC within recommended intervals. PCPs varied widely in their testing practices.

Roles of long non-coding RNAs in colorectal cancer tumorigenesis: A Review

Long non-coding RNAs (lncRNAs) are newly identified potential biological and gene regulators. Similar to other cell-free circulating cancer-related nucleic acids, lncRNAs are released in the peripheral circulation of cancer patients and allow for non-invasive gene expression assessment. lncRNAs are considered to be promising biomarkers for cancer prognosis and diagnosis. Several lncRNAs have been found to regulate developmental processes in a number of biological disorders. Recent studies indicated that lncRNAs are associated with numerous diseases, most notably cancer, as they were found to be highly expressed or silenced in a number of human cancers, including colorectal cancer (CRC). Despite advances in the current detection methods, over half of cancer patients succumb to the disease, as several CRC cases are diagnosed at an advanced stage. Due to the lack of non-invasive and low-cost prognostic and diagnostic tests for CRC, the identification of novel, potentially effective biomarkers has been attracting increasing attention in recent cancer research. The present review focused on the most widely applied lncRNAs in cancer detection, including CRC, in vitro.

Circulating tumor DNA-based mutational landscape of advanced colorectal cancer.

e15034 Background: Alterations in oncogenic driver genes are extensively tested to guide anticancer treatment in colorectal cancer (CRC). As the repertoire of therapeutic targets continue to grow, we are interested to interrogate the possibility of resorting to circulating tumor DNA (ctDNA) where tissue samples are not readily available. Methods: Targeted next generation sequencing (NGS) was performed on ctDNA obtained from patients with advanced CRC using a 150-gene panel. Mutational profiles of ctDNA were compared with those detected in tissue samples from the 3D Medicine database as well as The Cancer Genome Atlas (TCGA) database. Genomic aberrations such as single nucleotide variations (SNVs), insertions/deletions, copy number variations, gene rearrangement and fusions were analyzed. Results: Notably, 244 of 256 samples (95.3%) were ctDNA-positive, as indicated by a maximum somatic allele frequency (MSAF) of &gt; 0%. At least one reportable genomic alteration was detected in 96.5% of all cases, with an average of 8.12 mutations per case. The most frequently mutated genes were TP53 (47%), APC (42%), KRAS (32%) in ctDNA. A similar trend was also observed for SNVs, where TP53 (46.9% vs. 77.6% vs. 53.8%), APC (41.8% vs. 66.0% vs. 73.0%), and KRAS (30.5% vs. 48.4% vs. 43.5%) had the highest mutation frequencies across three data sets (ctDNA, tissues and the TCGA database). The SNV profiles of therapeutically relevant genes for CRC were also largely consistent between ctDNA and the tissue samples included in the 3D Medicine database: BRAF (7.0% vs. 8.7%), KRAS (30.5% vs. 48.4%), NRAS (2.7 vs. 3.1%), ERBB2 (5.1% vs. 5.2%), MLH1 (0.8% vs. 2.9%), MSH2 (2.7% vs. 3.1%), and MSH6 (3.1% vs. 3.7%). Patients harboring copy number gains had a significantly higher level of MSAF than those free of gene amplifications (p &lt; 0.0001). Conclusions: Mutational landscape of ctDNA in general correlated with that detected in prior tissue samples as well as the TCGA database, supporting a role for ctDNA testing as a complementary approach to tissue testing in CRC.

Mutational profiles and amplifications on circulating tumor DNA testing in patients with young-onset colorectal cancer.

e15067 Background: There has been a concerning rise of colorectal cancer (CRC) in young individuals (&lt;50 years). There appears to be a preponderance of left-sided tumors and rectal cancers, however, the etiology and biology is not entirely known. Our aim was to describe the results of circulating tumor DNA based (ctDNA) testing in young-onset CRC. Methods: We studied the results of 186 patients with CRC who had ctDNA testing, of whom 41 (22%) had young-onset CRC from January 2017 to January 2019 at Mayo Clinic, Florida. They were categorized based on their age at diagnosis. Results: The age distribution and the aberrations seen are summarized in the table. 25 (61%) were left sided, 9 (22%) were right sided, 7 (17%) were rectal tumors. ctDNA testing was able to identify mutations in 4 (9.8%) patients with BRAFV600E, 8 (19.5%) with RAS and categorized 29 (70.7%) as RAS/RAF wild-type. Furthermore, amplifications were detected in MYC 6 (14.6%) , MET 3 (7.3%) and ERBB2 1 (2.4%). 3(7.3%) were MSI-High and there were 4 individuals with BRCA1/2 noted on ctDNA testing. Conclusions: ctDNA testing for young onset CRC is feasible and identifies a spectrum of clinically meaningful and actionable aberrations. These can further be of use to evaluate treatment response, progression or help in selection of clinical trials. [Table: see text]

Knowledge and Practices of Colorectal Cancer Early Detection Examinations in Jordan: A Cross Sectional Study

Background:Globally, colorectal cancer (CRC) is ranked the third most common cancer among men and the second in women. The American Cancer Society recommends that starting from the age 50 years, both men and women should be screened for polyps and for early detection of CRC. In Jordan, CRC is the most common cancer among males and the second most common cancer among females. This study aims to assess the knowledge and practices of CRC early detection tests and the barriers and motivators of screening in Jordan.Methods:A semi-structured questionnaire and face-to-face interviews were conducted with 300 males and 300 females recruited using stratified clustered random sampling technique from four governorates in Jordan. The participants were aged 30 to 65 years, without a previous history of CRC. Descriptive and multivariate analyses were used to assess knowledge and practices of CRC early detection tests.Results:Overall, there were poor knowledge and practices of CRC early detection tests. Better knowledge and practices were significantly associated with previously consulting a doctor due to symptoms and worries from CRC, receiving a recommendation from a doctor to perform CRC testing, or having more knowledge about CRC signs and symptoms (p≤ 0.05).Conclusions:This study indicates that there is a need for raising awareness about CRC early detection tests in Jordan, especially among those aged 50 years and above, and those who have a family history of CRC. Additionally, it is important to educate and encourage physicians to recommend CRC screening to patients that are at higher risk of the disease.

Repeated Automated Mobile Text Messaging Reminders for Follow-Up of Positive Fecal Occult Blood Tests: Randomized Controlled Trial.

BackgroundFecal occult blood tests (FOBTs) are recommended by the US Preventive Services Task Force as a screening method for colorectal cancer (CRC), but they are only effective if positive results are followed by colonoscopy. Surprisingly, a large proportion of patients with a positive result do not follow this recommendation.ObjectiveThe objective of this study was to examine the effectiveness of text messaging (short message service, SMS) in increasing adherence to colonoscopy follow-up after a positive FOBT result.MethodsThis randomized controlled trial was conducted with patients who had positive CRC screening results. Randomization was stratified by residential district and socioeconomic status (SES). Subjects in the control group (n=238) received routine care that included an alert to the physician regarding the positive FOBT result. The intervention group (n=232) received routine care and 3 text messaging SMS reminders to visit their primary care physician. Adherence to colonoscopy was measured 120 days from the positive result. All patient information, including test results and colonoscopy completion, were obtained from their electronic medical records. Physicians of study patients completed an attitude survey regarding FOBT as a screening test for CRC. Intervention and control group variables (dependent and independent) were compared using chi-square test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for performing colonoscopy within 120 days for the intervention group compared with the control group while adjusting for potential confounders including age, gender, SES, district, ethnicity, and physicians’ attitude.ResultsOverall, 163 of the 232 patients in the intervention group and 112 of the 238 patients in the control group underwent colonoscopy within 120 days of the positive FOBT results (70.3% vs 47.1%; OR 2.17, 95% CI 1.49-3.17; P<.001); this association remained significant after adjusting for potential confounders (P=.001).ConclusionsA text message (SMS) reminder is an effective, simple, and inexpensive method for improving adherence among patients with positive colorectal screening results. This type of intervention could also be evaluated for other types of screening tests.Trial RegistrationClinicalTrials.gov NCT03642652; https://clinicaltrials.gov/ct2/show/NCT03642652 (Archived by WebCite at http://www.webcitation.org/74TlICijl)

Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

BackgroundHealth care reform is changing preventive services delivery. This study explored trajectories in colorectal cancer (CRC) testing over a 5-year period that included implementation of 16 Medicaid Accountable Care Organizations (ACOs, 2012) and Medicaid expansion (2014) – two provisions of the Affordable Care Act (ACA) - within the state of Oregon, USA.MethodsRetrospective analysis of Oregon’s Medicaid claims for enrollee’s eligible for CRC screening (50–64 years) spanning January 2010 through December 2014. Our analysis was conducted and refined April 2016 through June 2018. The analysis assessed the annual probability of patients receiving CRC testing and the modality used (e.g., colonoscopy, fecal testing) relative to a baseline year (2010). We hypothesized that CRC testing would increase following Medicaid ACO formation – called Coordinated Care Organizations (CCOs).ResultsA total of 132,424 unique Medicaid enrollees (representing 255,192 person-years) met inclusion criteria over the 5-year study. Controlling for demographic and regional factors, the predicted probability of CRC testing was significantly higher in 2014 (+ 1.4 percentage points, p < 0.001) compared to the 2010 baseline but not in 2012 or 2013. Increased fecal testing using Fecal Occult Blood Tests (FOBT) or Fecal Immunochemical Tests (FIT) played a prominent role in 2014. The uptick in statewide fecal testing appears driven primarily by a subset of CCOs.ConclusionsObserved CRC testing did not immediately increase following the transition to CCOs in 2012. However increased testing in 2014, may reflect a delay in implementation of interventions to increase CRC screening and/or a strong desire by newly insured Medicaid CCO members to receive preventive care.

Qualitative Investigation of FIT Colorectal Cancer Screening Uptake in an Uninsured Urban Minority Population

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the USA. Screening and prevention of CRC with stool testing and colonoscopy is cost effective and greatly reduces the risk for CRC and death. Fecal immunochemical testing (FIT) has been shown to be more accurate than guaiac testing for CRC and advanced adenoma detection. Our post-intervention analysis aims to identify barriers to FIT in patients who were provided with free FIT as part of a comprehensive cancer screening program. Methods: Validated standardized surveys were mailed to 100 patients who ‘returned' FIT kits and 100 patients who ‘refused to return' FIT kits (Image 1). Patients received a $5 gift card if they completed the questionnaire. Postage-paid return envelopes were included. Patients had two months to return the completed questionnaires. Results: A total of 17 ‘returned' questionnaires and 8 of ‘refused' questionnaires were completed. Of the 17 ‘returned' questionnaires, 13 were female and 4 were male. 8 of the ‘returned' respondents were African American, while 3 were Caucasian, 4 were Hispanic and 2 were Asian. Further demographics are shown in Image 2.2763_A Figure 1. Mailed Surveys2763_B Figure 2. Study DemographicsConclusion: We report low response rates for both questionnaires. This suggests that identifying barriers to FIT/colonoscopy screening remains challenging in an uninsured urban minority population. African American females with income <$10,000 were the predominant respondents from the ‘returned' cohort, which may indicate better screening uptake among this subpopulation. Six (35%) of ‘returned' respondents reported previous FIT, while none of the ‘refused' cohort had previous FIT. This may represent an unfamiliarity factor among ‘refused' respondents. Among the ‘returned' respondents, some of the identified reasons that influenced use of the FIT kit included lack of insurance, family history of colon polyps, interest in preventative screening and physician recommendation during an encounter for screening mammogram. ‘Difficult instructions' was listed as a reason for not using the FIT kit by 12.5% of the ‘refused' respondents while others from this cohort reported not receiving the kit or not having time to perform the testing. Although eliciting information regarding barriers to FIT kit use remains challenging, more study into this area is warranted to increase CRC screening rates.

Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death

Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow-up of abnormal results or when the screening test fails.We have few data on the contribution of each to CRC-associated deaths or factors associated with these events. We performed a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems (55-90 years old) who died of CRC from 2006 through 2012 and had ≥5 years of enrollment before diagnosis. We compared data from patients with those from a matched cohort of cancer-free patients in the same system. Receipt, results, indications, and follow-up of CRC tests in the10-year period before diagnosis were obtained from electronic databases and chart audits. Of 1750 CRC deaths, 75.9% (n= 1328) occurred in patients who were not up to date in screening and 24.1% (n= 422) occurred in patients who were up to date. Failure to screen was associated with fewer visits to primary care physicians. Of 3486 cancer-free patients, 44.6% were up to date in their screening. Patients who were up to date in their screening had a lower risk of CRC death (odds ratio, 0.38; 95% confidence interval, 0.33-0.44). Failure to screen, or failure to screen at appropriate intervals, occurred in a 67.8% of patients who died of CRC vs 53.2% of cancer-free patients; failure to follow-up on abnormal results occurred in 8.1% of patients who died of CRC vs 2.2% of cancer-free patients. CRC death was associated with higher odds of failure to screen or failure to screen at appropriate intervals (odds ratio, 2.40; 95% confidence interval, 2.07-2.77) and failure to follow-up on abnormal results (odds ratio, 7.26; 95% confidence interval, 5.26-10.03). Being up to date on screening substantially decreases the risk of CRC death. In 2 health care systems with high rates of screening, most people who died of CRC had failures in the screening process that could be rectified, such as failure to follow-up on abnormal findings; these significantly increased the risk for CRC death.

Complexities of genetic screening and testing in hereditary colorectal cancer

It is becoming increasingly important to identify patients at risk for hereditary colorectal cancer (CRC) given the opportunity to impact medical management and reduce morbidity and mortality among patients and their family members once inherited CRC predisposition is confirmed. Methods by which patients are identified are evolving as genetic testing costs have plummeted, resulting in many more genetic screening and testing options. Opportunities and challenges with newer approaches to genetic testing and screening for hereditary CRC are reviewed along with benefits and limitations of each approach. Regardless of how methods evolve for identifying patients with hereditary cancer risk, the need for patient education, family history taking, appropriate risk counseling, and enhancing sharing across family members will remain critical for optimal patient care.

Abstract 2204: Influence of chronic comorbidities on colorectal cancer screening adherence in a population-based Canadian cohort

Abstract Background: Regular screening for colorectal cancer (CRC) is associated with a lower stage at diagnosis and improved survival. National guidelines recommend periodic screening for adults aged 50-74 years. Chronic diseases may distract from regular screening and increase CRC burden. We sought to determine whether having certain chronic conditions is associated with a lower rate of CRC screening adherence. Methods: Using linked healthcare databases from Ontario, Canada, we assembled a population-based cohort of adults aged 50-74 years, who were eligible and overdue for routine CRC screening (fecal occult blood testing &amp;gt; 2 years, sigmoidoscopy &amp;gt; 5 years, or colonoscopy &amp;gt; 10 years) at any point between April 1, 2004 and March 31, 2016. We implemented Andersen-Gill extended Cox models for recurrent events using an age time scale to examine the impact of chronic conditions on the relative rate (RR, 95% confidence interval, CI) of becoming adherent with periodic CRC tests, adjusted for the relevant time-varying covariates. Results: During the 12-year observation window, included individuals contributed a total of 19,818,050 person-years spent overdue for CRC tests. Over 70% of all CRC tests performed during the study period were fecal occult blood tests. At baseline, of the 4,642,422 individuals that met the inclusion criteria, 31% had hypertension, 12% had diabetes, 9% had chronic obstructive pulmonary disease (COPD), 7% had mental illness, 5% had cardiovascular disease (CVD), 1.6% had congestive heart failure (CHF), and 0.1% had end-stage renal disease (ESRD). After adjustment for sociodemographic and health system factors, the highest rates of nonadherence were observed for ESRD on dialysis (RR 0.66, CI 0.63-0.68), CHF (RR 0.75, CI 0.75-0.76), COPD (RR 0.84, CI 0.83-0.84), CVD (RR 0.85, CI 0.84-0.85), diabetes (RR 0.86, CI 0.86-0.87), and mental illness (RR 0.88, CI 0.87-0.88). Hypertension (RR 0.98, CI 0.97-0.98) and ESRD with kidney transplant (RR 1.00, CI 0.84-1.19) were associated with modest to no risk. Conclusion: The presence of a major chronic condition is associated with lower adherence to CRC screening. Future studies should explore reasons for lower CRC screening adherence in individuals with chronic conditions and the appropriateness of secondary cancer prevention and early diagnosis in this population. Citation Format: Dominika Bhatia, Rinku Sutradhar, Jill Tinmouth, Simron Singh, Lorraine Lipscombe. Influence of chronic comorbidities on colorectal cancer screening adherence in a population-based Canadian cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2204.

Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study.

To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.

Lack of Knowledge and Negative Beliefs about Colorectal Cancer: FOBT and Dietary Risk Factors in Makkah, KSA

Colorectal cancer (CRC) is the third most common disease in males and second in females. A negative attitude about information such as prevalence, screening tests and poor dietary factors might increase risk. The aim was to measure knowledge and beliefs about screening test and some dietary factors. A cross-sectional study with 2564 participants was done. A validated questionnaire was used. SPSS (version 16) was used. The majority (60-80%) did not have knowledge about the risk of CRC. Only 25% knew it is widely occurring, about 22% knew it is higher in western society. Only about 5% men and 13% women realized the correct order to have CRC for their gender. Of total, 21% recognized that it is most common in men, yet, men scored better than women (23% vs 18%). Approximately 12% vs 17%, of men and women resp, have chosen FOBT as the screening test for CRC. Both genders understand the role of high fiber to reduce CRC (54% vs 63% men and women resp). In comparison, only about 10-13% of both genders do not believe that nor does cooking type neither obesity affect CRC risk negatively. More health programs to increase the awareness and changing wrong beliefs should be done.