The National Cancer Screening Program of Korea provides an annual fecal immunochemical test (FIT) for adults aged ≥50 years. We evaluated the diagnostic performance of colonoscopy and the prevalence ratio (PR) of advanced neoplasia (AN) in participants with positive FIT results under the National Cancer Screening Program between 2007 and 2024. The PR of AN was compared between binary groups created based on age, sex, waiting time to colonoscopy, FIT cutoff value, and anemia. Among the 2445 participants with positive FIT results, 1237 (50.6%) underwent colonoscopy. The positive predictive values for non-AN, AN, and sessile serrated lesions were 31.2%, 15.4%, and 14.6%, respectively. The PR of AN was 1.8 times higher in males than in females (P < .001) and 1.9 times higher in the standard FIT cutoff group than in the low FIT cutoff group (P < .001). In the multivariable analysis, male sex (PR = 1.84, 95% confidence interval: 1.36–2.50) and FIT positivity based on the standard cutoff (PR = 1.86, 95% confidence interval: 1.33–2.61) were significantly associated with AN (both P < .001). ANs were more frequently detected in male participants and when the standard FIT cutoff value was used in FIT-based colorectal cancer screening. Given the low colonoscopy completion rate of only 50.6%, colonoscopy completion should be recommended, particularly for male participants and those with positive FIT results based on the standard cutoff value.

Screening for colorectal cancer reduces mortality by enabling early detection. In Quebec, follow-up within 60 days after an incomplete colonoscopy is recommended. In this study, we sought to assess the impact of delays in follow-up on patient outcomes. In this retrospective study, we included adults who underwent a colonoscopy following a positive immunochemical fecal occult blood test at the Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier de l'université de Sherbrooke between Jan. 1, 2013, and Dec. 31, 2015. We verified colonoscopy adequacy and guideline adherence. We classified advanced polyps and colorectal cancer as clinically significant lesions (CSLs) to assess the clinical impact of incomplete or missing follow-up colonoscopies. In 89 cases of incomplete colonoscopies, inadequate bowel preparation was the leading cause of exam interruption (61.8%). A total of 57 patients had a subsequent follow-up, and 23 colonoscopies were completed within the 60-day time frame. Six CSLs, including advanced polyps and cancer, were detected within the recommended 60-day time frame, and 4 were identified after 60 days. We found a statistically significant difference in the rates of colorectal cancer diagnosis (p < 0.001), the need for surgery (p < 0.02), and death (p < 0.001) between patients who had a complete colonoscopy diagnostic process and those who did not. The poorer prognosis associated with patients who had a delayed or missing follow-up highlights the importance of respecting provincial guidelines concerning follow-up after incomplete colonoscopies.

Barriers and Strategies to Improve Colorectal Cancer Screening: Insights from a National Survey of African American Clinicians.

Abstract Background Colonoscopy is central to colorectal cancer (CRC) prevention, with its quality assessed by adenoma detection rate (ADR) and process measures like withdrawal time (WT). In inflammatory bowel disease (IBD) surveillance, the procedural and cognitive workload is higher, and IBD-specific tasks consume WT minutes. Yet, current guidelines provide no IBD-specific WT or ADR benchmark, and average-risk thresholds are routinely extrapolated to this cohort who faces twice the risk of CRC. Given the close link between WT and ADR, and consistent reports of lower IBD ADRs, concerns arise that standard WT targets are insufficient, and screening colonoscopy quality may be suboptimal in IBD patients. Aims Our primary aim was to evaluate colonoscopy quality by comparing ADR in screening-age IBD patients to non-IBD patient under a standardized WT. It was hypothesized that for equal WTs, the ADR in non-IBD cases would be higher than the one in IBD cases, and that longer WT would be necessary for colonoscopies performed on IBD patients to reach similar ADR levels as in non-IBD colonoscopies Methods We conducted a prospective observational study, using a video library of endoscopic procedures from our tertiary care center. All consecutive patients ≥45 years who underwent complete colonoscopy (2023-2025) were included. The primary outcome compared ADR between IBD and non-IBD groups, with adjustment for WT. Secondary outcomes assessed mean WT, polyp detection rate (PDR), advanced adenoma detection rate (AADR), and sessile serrated lesion detection rate (SSLDR) across both groups. Results We included 1507 colonoscopies (241 IBD, 1266 non-IBD). When WT was held constant at 11.7 minutes, the IBD group’s ADR (16.5%) was significantly lower than non-IBD (42.6%). ADR increased considerably faster with WT in non-IBD patients (16.8% vs 4.73% per minute). Achieving a 26% ADR required in 6.9 minutes of WT for non-IBD cases compared to 24.2 minutes for IBD. Furthermore, IBD colonoscopies had shorter mean WT (10.3 min vs 12.0 min). Conclusions ADR was considerably lower in IBD compared to non-IBD patients and increased far more slowly with additional WT in IBD. This suggest that a significant portion of procedural time and cognitive focus is devoted to IBD-specific tasks, thereby limiting mucosal observation for CRC precursors. Together, this shows that the current 8-minute WT target is insufficient for IBD surveillance and that average-risk thresholds are poorly suited to this high-risk cohort. We therefore recommend establishing IBD-specific quality indicators, including a tailored WT benchmark, to optimize CRC prevention strategies in this vulnerable population. Funding Agencies None

Long-term adherence and results with faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening are poorly characterised. To characterise adherence and results through seven rounds in an organised biennial FIT-based CRC screening programme. We determined per-round FIT-completion, FIT-positivity, CRC and high-risk-CRC precursor positive predictive values (PPVs) and CRC detection/1000-FIT-participants for all invitees versus an adherent cohort (entry 50-51 years; 66-100% rounds completed) versus comparable-age first-ever screenings from 2010 to 2023. Joinpoint and multivariable logistic regression analyses identified trends. Adherence was consistent, frequent, occasional, infrequent and never (defined as 100%, 66-99%, 33-65%, 1-32%, 0% of rounds offered) in 29.2%, 8.6%, 11.5%, 4.5% and 46.2% of 2.81 million individuals, respectively. In both the all-invitee population and the adherent cohort, the first round yielded the highest FIT positivity (5.8%, 4.4%), PPVs for CRC (5.1%, 3.3%) and high-risk precursors (20.4%, 13.1%), and CRC detection rates (2.65, 1.30 per 1000 participants), respectively. Beyond three rounds, outcomes stabilised at levels substantially lower than those observed in first-time screeners of the same age (eg, CRC-PPV in seventh round: 1.6-2.2% at median age 62-65 vs 6.6% for new screeners aged 62-63). Colonoscopy completion after a positive FIT was high (87.3%). After an initial round with the highest FIT-positivity and detection rates, screening outcomes stabilise at lower levels reflecting neoplasia removal and subsequent selection of a lower-risk population. Because detection rates remain clinically relevant even in an adherent cohort, early screening cessation after a sequence of normal biennial FITs is not justified.

Colorectal cancer mortality is elevated among people with intellectual disabilities, potentially because of delayed diagnosis. To compare colorectal cancer screening participation and completion among people with and without intellectual disabilities. This nationwide, register-based cohort study was conducted in Denmark, where all residents aged 50 to 74 years are invited to biennial, free-of-charge colorectal cancer screening. People with and without intellectual disabilities born between 1940 and 1973 and invited to colorectal cancer screening at least once between 2014 and 2023 were included. Intellectual disability, defined as being registered with an intellectual disability diagnosis or a diagnosis most likely leading to intellectual disability. Disability severity (mild, moderate, severe, and profound) was available for a subpopulation. The primary outcomes were colorectal cancer screening participation and completion, including stool sample return, screening results, and diagnostic examination (mainly colonoscopy) following a positive screening test result. The pseudo-observations method was used to estimate cumulative incidence differences and cumulative incidence ratios between people with and without intellectual disability. The study included 17 117 people with (median [IQR] age, 55.2 [50.2 to 63.2] years; 8445 female [49.3%]) and 149 162 without (median [IQR] age, 54.8 [50.2 to 62.5] years; 75 324 female [50.5%]) intellectual disabilities. Among those, 5170 people with intellectual disabilities (30.2%) and 83 709 people without (56.1%) returned a stool sample within 90 days of first invitation (adjusted cumulative incidence difference, -23.2 percentage points; 95% CI, -24.0 to -22.4 percentage points), with participation increasing with disability severity (range, 1453 of 5293 individuals with mild [27.5%] to 198 of 488 individuals with profound [40.6%] intellectual disabilities). Nonanalyzable samples were more common among people with vs without intellectual disabilities (105 individuals [1.8%] vs 330 individuals [0.4%]). Among those with a positive screening test result, 347 people (70.5%) with intellectual disabilities and 4724 (90.2%) without underwent diagnostic examination (mainly colonoscopy) within 60 days (adjusted cumulative incidence difference, -17.9 percentage points; 95% CI, -22.1 to -13.7 percentage points). The proportion who underwent diagnostic examination decreased with increasing disability severity (range, 127 of 165 individuals with mild [77.0%] to 50 of 100 individuals with moderate to profound [50.0%] intellectual disabilities). Colonoscopies were more often incomplete among people with vs those without intellectual disabilities (109 individuals [28.2%] vs 673 individuals [13.8%]). In this cohort study of people with and without intellectual disabilities, those with intellectual disabilities were less likely to participate in colorectal cancer screening and, when they did participate, more often encountered challenges with stool sample collection and colonoscopy completion. These disparities call for tailored, decision-supportive strategies to ensure equitable access to colorectal cancer screening.

Colorectal cancer (CRC) screening is recommended for average-risk individuals aged 45-75 years old; however, screening rates are suboptimal. An evidence-based strategy found to be effective at increasing screening uptake is patient navigation. The purpose of this paper is to describe patient navigation activities delivered in an effective culturally tailored community-based colorectal cancer screening program in an unscreened, underserved and predominantly Hispanic population. A total of 690 participants recruited between March 2012 and January 2015 were eligible to receive a colonoscopy. A random sample of 100 high-risk participants and 100 participants who had a positive FIT test were selected for inclusion. We characterized participant identified barriers, navigation contact types, frequency and duration. Linear and logistic regression models were used to examine associations between sociodemographic and health-related factors and two outcomes: (1) the number of navigation activities participants required, and (2) whether participants reported experiencing at least one barrier to screening. The average age of participants in our sample was 56.3 years (SD = 5.72), with the majority being female (74.0%) and Hispanic (96.5%). On average, participants received 9.66 navigation contacts in the program, and navigators spent 54.89min per participant delivering navigation services. The most common activities identified were scheduling appointments, reminder phone calls, and communicating results. These results provide detailed information about type and duration of navigation activities for CRC screening and colonoscopy completion within an effective community-based CRC screening program designed for and underserved and underscreened population.

BackgroundWe implemented a centralized colorectal cancer (CRC) screening program with navigation to follow-up colonoscopy for community health center (CHC) patients with positive stool-based test screening results. Navigation increased six-month colonoscopy completion by 24 percentage points compared with usual care. Here, we describe how we applied a functions and forms framework alongside causal loop diagramming (CLD) to understand the effectiveness of our navigation program and explore its potential for implementation in other settings.MethodsWe first identified barriers to colonoscopy completion in our primarily rural sample and detailed the navigation services provided. Next, we classified our program into core functions (key components contributing to success) and corresponding forms (elements detailing how the functions were carried out and adapted to the local context). To inform classification, we reviewed program documentation (e.g., implementer notes, call logs, and protocol). We refined findings collaboratively in workshops with the navigation team and leadership. We also conducted CLD sessions to document and visualize how the functions addressed the problems affecting colonoscopy completion, refining our list of functions and forms based on these findings.ResultsWe identified nine key functions of our navigation program – bridging across patients, providers, and systems; reaching and engaging patients; building rapport and trust; identifying and alleviating concerns; developing readiness and self-efficacy; linking to resources; monitoring progress; enhancing communication; and providing consistent, high-quality navigation services. We documented 29 distinct forms operationalizing these functions within our local context (e.g., motivational interviewing to address barriers and support self-efficacy). We developed a causal loop diagram to explore interactions among the multi-level factors affecting colonoscopy completion and how the navigation program addressed those factors.DiscussionOrganizing functions and forms clarified core elements of success and aspects adaptable for scale-up or replication across different contexts. CLD provided insights into how the functions contributed to the program’s success and helped identify additional forms. Findings will guide efforts to translate this navigation model to varied contexts.Study registrationClinicalTrials.gov Identifier: NCT04406714.Supplementary InformationThe online version contains supplementary material available at 10.1186/s43058-026-00858-6.

The role of health, sociodemographic, and care delivery factors in timely completion of colonoscopy in a US-based primary care population: a retrospective analysis.

Increasing timely colonoscopy surveillance for patients with high-risk colorectal polyps: Protocol for a cluster randomized trial.

Rectal bleeding is a common concern among primary care patients and a risk marker for colorectal cancer. Yet, primary care patients who present with rectal bleeding frequently do not complete timely colonoscopies. We sought to determine if a phone-based, scheduling intervention for patients presenting with rectal bleeding in primary care would improve the rate of scheduling and completion of ordered colonoscopies. We conducted a nonrandomized pre-post intervention study at an urban, academic, hospital-based primary care clinic. We included patients with a colonoscopy order for rectal bleeding who had not scheduled a colonoscopy within 2 weeks of the order date. We created a baseline cohort from August to October 2022 and an intervention cohort from November 2022 to June 2023. The pilot intervention involved up-to-3 outreach phone calls by a primary care-based phone service representative to study participants. Compared to the baseline cohort, patients in the intervention cohort had a significantly higher rate of colonoscopy completion at 365 days ( p = .04). Higher rates in loop closure were seen across demographic cohorts. Proactive, primary care-based, outreach phone calls increased rates of completion of colonoscopies ordered for rectal bleeding.

Abstract Background High-quality endoscopy in inflammatory bowel disease (IBD) is associated with improved clinical outcomes and forms the basis for quality assurance. The European Society of Gastrointestinal Endoscopy (ESGE) recommends nine key performance measures for quality control in IBD-related colonoscopy. This study aimed to compare colonoscopy quality indicators in IBD across different levels of care. Methods In this nationwide cross-sectional study, we analyzed colonoscopy reports of patients with IBD. We consecutively enrolled patients over 18 years old with established IBD between January and October 2025, using their available colonoscopy reports. The tertiary care group included colonoscopy reports from the most recent complete colonoscopy performed at tertiary IBD centers in Pécs, Budapest, and Szeged. The secondary care group included the most recent colonoscopy reports performed at secondary care institutions for patients later referred to tertiary centers, based on estimated sample size. Nine key performance measures (indication, bowel preparation, photo documentation, ileal intubation, biopsy, endoscopic activity score, high-definition and chromoendoscopy use, and neoplasia detection) were evaluated, while. patients were also analyzed according to the indication for colonoscopy (diagnostic, disease activity assessment, or surveillance). Results A total of 397 colonoscopy reports were evaluated, of which 158/397 were performed in secondary care, while 51.4% of patients had Crohn’s disease. Disease activity assessment (91% vs. 55%, p &amp;lt; 0.001), surveillance procedures (1.4% vs. 0%), and biopsy sampling in the number and location according to the recommendations (81% vs. 65%, p &amp;lt; 0.001) were more frequently performed in tertiary centers. Documentation of Boston Bowel Preparation Scale was more frequent in tertiary centers (97.1% vs. 55%; p &amp;lt; 0.001). Use of endoscopic activity scoring systems was also higher in tertiary care (51.9% vs. 14.0%; p &amp;lt; 0.001), as was ileal intubation (65% vs. 43%; p &amp;lt; 0.001). Withdrawal and total procedure times did not differ significantly between levels, and surveillance procedures were not assessed in this analysis. Conclusion The performance of colonoscopy quality indicators remains below guideline-recommended targets; however, results were consistently higher at the tertiary care level. Targeted educational initiatives led by national and international societies are needed to support gastroenterologists in improving colonoscopy quality in IBD.

Colorectal cancer screening is an effective strategy to prevent disease, reduce the risk of advanced-stage diagnosis, and improve survival. Timely follow-up of abnormal screening results, particularly abnormal fecal immunochemical tests, is essential to realizing these benefits. This qualitative study examined routine processes related to colonoscopy referral and completion for patients of a federally qualified health center (FQHC) referred to community gastroenterology (GI) practices. Using a snowball sampling approach, five FQHC individuals and eight community GI practice individuals were interviewed. Interviews at the FQHC were conducted between March 2020 and September 2021, during the early phase of the coronavirus disease 2019 pandemic. Due to clinic closures and other pandemic-related disruptions, GI practice interviews occurred between August 2021 and January 2023. Study findings highlight the need for improved communication and collaboration between primary care and GI practices to support colonoscopy completion among low resource populations. Interviewees also offered recommendations to ensure colonoscopy completion. Further research is needed to pilot test centralized referral and scheduling systems and to develop multicomponent interventions that address both patient and organizational barriers to colonoscopy completion.

Colorectal cancer (CRC) incidence is increasing in low- and middle-income countries, where late-stage presentation is common and survival rates remain poor. Early-detection programs are critical to improving outcomes. A longitudinal early-detection study was conducted in Osun State, Nigeria. A 6-month community awareness campaign was implemented with posters, radio jingles, social media, and messaging disseminated via health and religious institutions. CRC knowledge was assessed before and after the intervention with the validated Bowel Cancer Awareness Measure questionnaire. Individuals with indicators of CRC were referred from peripheral facilities to an early-diagnosis (ED) clinic at a tertiary center. Demographic data, presenting features, and diagnostic outcomes were prospectively recorded. The primary end point was detection of advanced adenomas and CRC. Of 497 eligible participants, 322 (64.8%) completed pre- and postcampaign surveys. Awareness of CRC improved from 54 (16.8%) to 311 (96.9%) (p<.001). Good knowledge of CRC risk factors and symptoms also increased significantly (p<.001). A total of 329 individuals were navigated to the ED clinic; 168 (51.1%) were eligible for the protocol, and 116 (73.0%) completed colonoscopy. CRC was diagnosed in four patients (3.4%), with stage 0 (n=2), II (n=1), and III (n=1). Advanced adenomas were identified in 11% of patients (13 of 116) who underwent colonoscopy. Combining community engagement with patient navigation significantly increased CRC awareness and enabled the detection of advanced adenomas and early-stage cancers. Expanding this model to a national level is recommended to evaluate broader impact, cost-effectiveness, and potential implementation challenges.

Patients treated for stage I to III colorectal cancer are at high risk for developing new and recurrent colon cancers. Therefore, professional organizations recommend a surveillance colonoscopy approximately 1-year postsurgical resection to ensure early detection. Despite these guidelines, surveillance colonoscopy completion rates remain suboptimal. This multimethods study aimed to explore patient-identified barriers and facilitators affecting the completion of 1-year surveillance colonoscopies among stage I to III colorectal cancer survivors. Multimethods study. The study was conducted within the Hutchinson Institute for Cancer Outcomes Research Value in Cancer Care Network, which comprises 46 clinics across 13 counties in Washington State. We enrolled stage I to III colorectal cancer survivors who had not completed surveillance colonoscopy within 18 months of surgery. Participants completed questionnaires and semistructured interviews between December 2023 and June 2024. Questionnaire data and interview transcripts were independently coded and analyzed by 2 coders to identify key themes and subthemes related to barriers and facilitators of surveillance colonoscopy completion. The study included 19 patients. The median (interquartile range) participant age was 73 (17.8) years, 9 (47.4%) were men, and 8 (42.1%) had stage I cancer. All participants reported cognitive and environmental factors as both barriers and facilitators to surveillance colonoscopy completion. The most reported barriers were fear of the colonoscopy results and cancer recurrence (cognitive) and challenges with the bowel preparation (environmental). The most frequently reported facilitators were patient's motivation to receive reassurance (cognitive) and clinic assistance in scheduling appointments (environmental). Results may not be generalizable due to population and selection bias of participants. This study identified barriers and facilitators to completing a 1-year surveillance colonoscopy, which will guide future interventions. Addressing both psychological concerns and improving communication between patients and clinics could be key strategies to enhance adherence rates and improve long-term outcomes for colorectal cancer survivors. See Video Abstract . ANTECEDENTES:Los pacientes tratados por cáncer colorrectal en estadio I-III corren un alto riesgo de desarrollar nuevos cánceres de colon y de que estos reaparezcan. Por lo tanto, las organizaciones profesionales recomiendan una colonoscopia de vigilancia aproximadamente un año después de la resección quirúrgica para garantizar la detección precoz. A pesar de estas directrices, las tasas de realización de colonoscopias de vigilancia siguen siendo insuficientes.OBJETIVO:Este estudio multimétodo tenía como objetivo explorar las barreras y los facilitadores identificados por los pacientes que afectan a la realización de colonoscopias de vigilancia al año entre los supervivientes de cáncer colorrectal en estadio I-III.DISEÑO:Estudio multimétodo.ENTORNO:El estudio se llevó a cabo en el Hutchinson Institute for Cancer Outcomes Research Value in Cancer Care Network, que comprende 46 clínicas en 13 condados del estado de Washington.PACIENTES:Se inscribieron supervivientes de cáncer colorrectal en estadio I-III que no habían completado la colonoscopia de vigilancia en los 18 meses posteriores a la cirugía. Los participantes completaron cuestionarios y entrevistas semiestructuradas entre diciembre de 2023 y junio de 2024.PRINCIPALES MEDIDAS DE RESULTADOS:Los datos de los cuestionarios y las transcripciones de las entrevistas fueron codificados y analizados de forma independiente por dos codificadores para identificar los temas y subtemas clave relacionados con las barreras y los facilitadores de la realización de la colonoscopia de vigilancia.RESULTADOS:El estudio incluyó a diecinueve pacientes. La mediana (rango intercuartílico) de la edad de los participantes fue de 73 (17,8) años, 9 (47,4 %) eran hombres y 8 (42,1 %) tenían cáncer en estadio I. Todos los participantes informaron de factores cognitivos y ambientales como barreras o facilitadores para completar la colonoscopia de vigilancia. Las barreras más mencionadas fueron el miedo a los resultados de la colonoscopia y a la recurrencia del cáncer (cognitivo) y las dificultades con la preparación intestinal (ambiental). Los facilitadores más frecuentes fueron la motivación del paciente para recibir tranquilidad (cognitivo) y la ayuda de la clínica para programar las citas (ambiental).LIMITACIONES:Los resultados pueden no ser generalizables debido al sesgo de selección de la población y de los participantes.CONCLUSIONES:Este estudio identificó barreras y facilitadores para completar una colonoscopia de vigilancia anual con el fin de orientar futuras intervenciones. Abordar las preocupaciones psicológicas y mejorar la comunicación entre los pacientes y las clínicas podrían ser estrategias clave para mejorar las tasas de adherencia y los resultados a largo plazo de los supervivientes de cáncer colorrectal. ( AI-generated translation ).

If a complete optical colonoscopy (OC) cannot be performed, an alternative diagnostic method should be considered.The aim of this retrospective chart review study was to investigate the surgical and interventional endoscopic implications of CT colonography (CTC) after fully intended but aborted OC.302 patients with CTC after an incomplete OC were compared to sex-matched controls who underwent a complete OC by the same examiner in the same year. The most common indications were preventive colonoscopy (29.1%) and pathological iFOBT (9.6%). The most common reasons for OC discontinuation were suspected adhesions (n=64) and a long sigmoid colon ± non-inflammatory diverticula (n=59). OC discontinuation was most prevalent in the sigmoid colon (n=149, 49.3%). Adenoma detection rates in patients undergoing preventive colonoscopy were 9.6 and 26.9 per cent in the CTC and the control groups, respectively (p<0.01). A total of 384 extracolonic CT findings were identified in 197 patients (65.2%) including 373 benign (97.1%) and 11 potentially malignant findings (2.9%). However, only two of these could be confirmed histologically.In our cohort, CTC revealed only a small number of (pre-)malignant (extra-)intestinal findings. Therefore, we recommend a limited use of CTC, depending on the indication and the local findings that led to the discontinuation of OC.

Colorectal cancer burden is increasing in Mexico. Population-based screening programs will be needed to address this public health challenge. Our objective was to explore the feasibility of offering colorectal cancer screening (CRCS) with a fecal immunochemical test (FIT) kit in the context of an existing door-to-door vaccination program in Mexico City. The study was conducted in Mexico City in 2019-2020, before and during the onset of the COVID-19 pandemic. Design of the intervention was informed by focus group interviews with average-risk adults age 50-75 years served by a door-to-door vaccination program and interviews with primary care clinic and hospital staff serving this community. The intervention involved offering FIT to household members age 50-75 years during routine door-to-door immunization campaigns, with follow-up colonoscopy for those with abnormal results. Feasibility and acceptability of the intervention was evaluated through analysis of patient participation, clinical outcomes, and surveys. A total of 132/178 (74.2%) eligible community participants accepted a FIT kit after receiving information from a trained health promoter. Mean age of participants was 62.0 (±6.8) years, and most were women (n = 84, 63.6%). Among participants, 94 (71.2%) returned FIT for testing. Of these, 20 (21.3%) had an abnormal FIT result (≥20 ngHg/mL) and were offered colonoscopy. Of these, 10 (50%) completed the colonoscopy. Recruitment was halted due to the COVID-19 pandemic, which also became a barrier to colonoscopy completion. Offering CRCS with FIT during door-to-door vaccination activities was feasible and acceptable to outreach workers and patients. Further studies are needed to determine interventions and implementation strategies necessary for scale-up and the effectiveness within integrated health systems.

BackgroundFecal immunochemical testing (FIT) is a widely implemented noninvasive screening tool for colorectal cancer (CRC). While FIT detects occult gastrointestinal (GI) bleeding, the relationship between systemic blood hemoglobin (Hb) levels and significant colorectal pathology (SCP) among FIT-positive patients remains uncertain. Identifying such an association could improve clinical triage and resource allocation in screening programs.MethodologyThis retrospective observational study was conducted at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. All adults (≥18 years) who tested positive on FIT and subsequently underwent complete colonoscopy between December 2024 and September 2025 were included. Patients with incomplete colonoscopy, inadequate bowel preparation, missing Hb data, active non-colorectal GI bleeding, hematologic disorders, or prior colorectal surgery or malignancy were excluded. Pre-colonoscopy Hb was obtained within 12 weeks of colonoscopy. SCP was defined as tubular adenoma, tubulovillous adenoma, or adenocarcinoma. Hb levels were compared across pathology groups using the Kruskal-Wallis test, and anemia prevalence was analyzed using the chi-square test.ResultsAmong 483 FIT-positive patients, 182 met the inclusion criteria. The mean age was 59.3 ± 11.8 years, and 55% were male. The median pre-colonoscopy Hb level was 13.9 g/dL (interquartile range (IQR) 12.7-15.0). Histopathology revealed tubular adenoma in 89 (48.9%), tubulovillous adenoma in 35 (19.2%), adenocarcinoma in 23 (12.6%), hyperplastic polyps in 16 (8.8%), and other benign lesions in 19 (10.4%). Median Hb differed slightly across groups, lowest in adenocarcinoma (12.8 g/dL) and highest in benign lesions (14.8 g/dL), but the difference was not statistically significant (P = 0.245). Overall, 139 (76%) patients, including 78% with adenocarcinoma, had normal Hb levels.ConclusionsNo significant correlation was observed between pre-colonoscopy blood hemoglobin and SCP among FIT-positive patients. Most individuals with advanced neoplasia had normal Hb concentrations, indicating that systemic hemoglobin is not a reliable predictor of malignancy in this population. Normal Hb should not be considered reassuring and must not delay colonoscopic evaluation following a positive FIT result.

Despite effective screening tools, colorectal cancer (CRC) screening uptake remains low in Malaysia. We aimed to determine whether a locally contextualized patient navigation programme could improve adherence to and reduce the psychological impact of screening colonoscopy. A pilot study determined barriers to colonoscopy adherence. The navigation programme was developed (phase 1), and navigators trained (phase 2). Fifty-two average-risk patients with positive immunochemical faecal occult blood tests were randomized to the patient navigation programme (intervention) or standard care (control) (phase 3). The primary outcome was adherence to colonoscopy. Secondary outcomes, assessed pre-colonoscopy and post-colonoscopy, used the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-12 (GHQ-12) scores. Navigated patients were 2.4 times more likely to complete colonoscopy (P < .001), had significant reduction in anxiety (P < .001) and depression (P = .008) while general wellbeing was better (P < .001) compared with controls. This culturally contextualized navigation programme is effective in improving adherence to colonoscopy, with reduction in anxiety, depression and general psychological distress. Wider implementation should be considered in national CRC screening strategies to improve effectiveness.

Simple SummaryDespite strong evidence supporting colorectal cancer (CRC) screening, follow-up colonoscopy rates after abnormal fecal immunochemical tests (FITs) remain low, particularly in underserved rural populations. This study evaluated the implementation of a patient navigation program within a large, pragmatic trial targeting Medicaid enrollees in rural primary care settings. A total of 35 patients were eligible for navigation due to abnormal FIT results (n = 26) or elevated CRC risk (n = 9); only 8 of 14 intervention clinics had any eligible patients. Among those with abnormal FITs, 50% received navigation, and 23% completed diagnostic colonoscopy. While higher-risk patients received navigation, none completed follow-up. Implementation was hindered by staffing disruptions, limited access to colonoscopy, patient mistrust, and data infrastructure challenges. Facilitators included cross-clinic collaboration and flexible adaptation of navigation protocols in low-volume environments. Future models may benefit from centralized coordination with endoscopy providers and payer-based quality improvement strategies.Background/Objectives: Despite its effectiveness, colorectal cancer (CRC) screening rates are suboptimal in the United States. Navigating patients towards complete CRC screening can be effective in addressing barriers. However, to date, much research on patient navigation has occurred in urban settings or large health systems, thereby missing some populations that could benefit the most. Methods: We report on a patient navigation program delivered by clinic staff during a large pragmatic study to improve CRC screening in rural Medicaid populations. We use qualitative and implementation data from interviews, contract logs, and tracking systems to explore the context, barriers, and facilitators of patient navigation, as well as feasibility and acceptability for rural primary care clinic partners. Results: A total of 35 patients were eligible for navigation following an abnormal FIT (n = 26, 74%) or due to higher CRC risk (n = 9, 24%); only 8 of the 14 intervention clinics (57%) had any eligible patients. Of the 26 patients who needed navigation following an abnormal FIT, 13 patients (50%) received navigation, and 3 (23%) completed a colonoscopy; all 9 of the higher-risk patients received navigation, but none completed colonoscopy. Several barriers impacted adherence to the navigation protocol, such as staffing disruptions, limited colonoscopy availability, patient mistrust, and data tracking limitations. Our findings also highlight implementation facilitators, including protocol adaptations and cross-team collaborations for low-volume settings. Conclusions: Future models to increase patient navigation in rural settings could include more centralized system-level interventions that build on relationships between clinics and colonoscopy providers or payers and leverage quality improvement best practices.