Colorectal Cancer Screening Compliance Research Articles

Assessing Colorectal Cancer Prevention and Screening Knowledge in the Population of Puerto Rico

Introduction: In Puerto Rico (PR), both colorectal cancer (CRC) incidence and mortality rates are increasing. Moreover, adherence rates to CRC screening are still below Healthy People 2020 goals. Lack of knowledge is described as a significant barrier to compliance for CRC screening. Thus, this study aimed to assess the knowledge of CRC among PR adults. Methods: Participants aged 40-85 years were recruited. Demographic characteristics and knowledge (13 items) about CRC, risk factors and screening tests were determined through a face-to-face interview. A mean knowledge score was computed by summing correct responses. Mean knowledge scores were evaluated according to demographics characteristics using the Wilcoxon-Mann-Whitney test. Results: A total of 101 participants were recruited. Mean age was 63 years (range 40-85). Fifty-nine (58%) were females, 59% have reported ≥ 12 years of education and 71% have reported screening for CRC. Mean knowledge was 9.1 ± 0.3. Mean knowledge score was significantly higher (p < 0.05) among those with a higher annual family income, those who have ever received a recommendation for CRC screening by a healthcare provider and those with history of CRC screening. Conclusion: CRC education must be improved. Further studies should focus on identifying and reducing barriers for CRC screening.

Feasibility study of minimal prepared hydroflush screening colonoscopy.

Although screening colonoscopy is effective for early detection of colorectal cancer (CRC), screening rates remain low. Multiple factors are thought to be responsible for the low rates of screening colonoscopy, but bowel preparation appears to be a key deterrent. Tolerability issues with bowel preparations may lead to poor patient compliance, inadequate colon cleansing, and reduced detection of colonic polyps. The aim of this article is to evaluate the feasibility, safety, and outcomes of minimally prepared intra-procedural hydroflush technique as an alternative to traditional bowel preparation in screening colonoscopy. We conducted a prospective feasibility study of intraprocedural hydroflush technique aided by water-jet pumps and a mechanical suction novel device following minimal bowel preparation for CRC screening. Nine procedures were performed in nine healthy individuals scheduled for routine screening colonoscopy. Preparation included mild diet restriction, laxative tablets two to three days prior to the procedure and two Fleet enemas one to two hours before the colonoscopy. The cleanliness of the colon was assessed by using the Boston bowel preparation scale. Insertion and withdrawal times were recorded. Complete colonoscopy to the cecum was performed in all patients (100%). Mean time to the cecum was 5.78 ± 2.68 minutes, and mean withdrawal time was 15.33 ± 3.94 minutes. Endoscopic visualization of the entire mucosa was achieved in all cases with no colonoscopy repeated because of inadequate preparation. Four polyps have been detected and removed in three patients. Mild mucosal erosions were seen in some areas where the suction was used extensively, similar to those that can be seen during conventional colonoscopy. Mild stiffness of the shaft of the scope was noted. This was an uncontrolled feasibility study of selected patients. Minimally prepared colonoscopy with the intra-procedural hydroflush technique for colorectal screening is feasible. The water exchange technology compensates for the mild stiffness of the scope. This technique might increase patients' compliance for CRC screening.

Race and Colorectal Cancer Screening Compliance Among Persons With a Family History of Cancer

Introduction: The risk of cancer is often higher among families when a family member has a history of cancer. It is unclear whether less than optimal uptake of preventive services contributes to this increased risk of cancer. Aim: To determine adherence to colorectal cancer (CRC) screening guidelines among persons with a family history of any type of cancer and investigate racial differences in screening adherence. Methods: We used the 2007 Health Information National Trends Survey (HINTS) and identified 4,232 respondents (weighted population size = 80,161,151) who were at least 50 years old and did not have a personal history of CRC. We defined being current with CRC screening as the use of fecal occult blood testing (FOBT) within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We compared being up-to-date with CRC screening among those with and without a family member with a history of cancer. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI). Survey weights were used in all analyses and variance estimations were performed using Taylor series linearization to account for the complex survey design. Results: There were 1,094 (27.4%) respondents without a family history of cancer and 3,138 (72.6%) with a family history of cancer. Overall, when compared with respondents without a family history of cancer, those with a family member with cancer were more likely to be current with CRC screening (64.9% versus 55.1%; OR = 1.47; 95%CI: 1.23-1.76) regardless of screening modality. This was due to endoscopy uptake (59.5% versus 49.3%; OR = 1.49; 95%CI: 1.26-1.76) and not with FOBT (15.6% versus 14.6%; OR = 1.13; 95%CI: 0.86-1.49). Blacks had lower screening rates in general and screening rates among blacks with a family history of cancer was not higher than whites without a family history of cancer (Table). Conclusion: Adults with a family history of any cancer were more likely to be screened for CRC. However, increased burden from CRC among blacks may be related to poor uptake of screening among high-risk groups.Table 1: Comparison of being up-to-date with CRC screening by racial distribution of family history of any cancer

A population management system for improving colorectal cancer screening in a primary care setting.

Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors. Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines. A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls. Six suites within an academic primary care practice. 5320 adults eligible for CRC screening treated by 70 doctors. In three intervention suites, doctors reviewed real-time rosters of patients due for CRC screening and chose practice delegate outreach or default reminder letter. Delegates tracked overdue patients, made outreach calls, facilitated test ordering, obtained records and documented patient deferral, exclusion or decline. In three control suites, doctors followed usual preventive care practices. CRC screening compliance (including documented decline, deferral or exclusion) and CRC screening completion rates over 5 months. At baseline, there was no significant difference in CRC screening compliance (I: 80.4% and C: 79.6%, P = 0.439) and CRC screening completion rates (I: 78.3% and C: 77.3%, P = 0.398) between intervention and control groups. Post-intervention, compliance rates (I: 88.1% and C: 80.5%, P < 0.01) and completion rates (I: 81.0% and C: 78.1%, P < 0.05) were significantly higher in the intervention group. A population management system using closed-loop communication may improve CRC screening compliance and completion rates within academic primary care practices. Team-based care using well-designed IT systems can enable sharing of patient care responsibilities and improve patient outcomes.

Review of computed tomographic colonography from a surgeon's perspective.

New research has addressed many of the early concerns of computed tomographic colonography (CTC) and these studies are now beginning to shape clinical practices. A review of the literature demonstrates that the sensitivity of CTC in screening for large polyps (>/= 1cm) or cancers in the large intestine is as high as that of conventional optical colonoscopy, however, the sensitivity decreases with the diameter of the polyp. Despite this, CTC is well tolerated, more acceptable to patients than optical colonoscopy and therefore may improve colorectal cancer screening compliance. This review not only describes the diagnostic accuracy and sensitivity of CTC, and the evolving role of CTC as a primary colon cancer screening option, but also the recent studies that have demonstrated the additional value of CTC utilization for practicing clinicians.

Race and colorectal cancer screening compliance among persons with a family history of cancer.

To determine compliance to colorectal cancer (CRC) screening guidelines among persons with a family history of any type of cancer and investigate racial differences in screening compliance. We used the 2007 Health Information National Trends Survey and identified 1094 (27.4%) respondents (weighted population size = 21959672) without a family history of cancer and 3138 (72.6%) respondents (weighted population size = 58201479) with a family history of cancer who were 50 years and older. We defined compliance with CRC screening as the use of fecal occult blood testing within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We compared compliance with CRC screening among those with and without a family member with a history of cancer. Overall, those with a family member with cancer were more likely to be compliant with CRC screening (64.9% vs 55.1%; OR = 1.45; 95%CI: 1.20-1.74). The absolute increase in screening rates associated with family history of cancer was 8.2% among whites. Hispanics had lowest screening rates among those without family history of cancer 41.9% but had highest absolute increase (14.7%) in CRC screening rate when they have a family member with cancer. Blacks had the lowest absolute increase in CRC screening (5.3%) when a family member has a known history of cancer. However, the noted increase in screening rates among blacks and Hispanics when they have a family member with cancer were not higher than whites without a family history of cancer: (54.5% vs 58.7%; OR = 1.16; 95%CI: 0.72-1.88) for blacks and (56.7% vs 58.7%; OR = 1.25; 95%CI: 0.72-2.18) for Hispanics. While adults with a family history of any cancer were more likely to be compliant with CRC screening guidelines irrespective of race/ethnicity, blacks and Hispanics with a family history of cancer were less likely to be compliant than whites without a family history. Increased burden from CRC among blacks may be related to poor uptake of screening among high-risk groups.

Will CT colonography improve colorectal cancer screening compliance?

Colorectal cancer (CRC) is the third most common cancer in men and women in the USA and is the second leading cause of cancer death. Despite the widespread publication of evidence-based, expert consensus guidelines for the screening and surveillance of CRC, overall adherence to CRC screening recommendations remains suboptimal. CT colonography (CTC) is a minimally invasive, sedation-free CRC screening modality that has demonstrated comparable ability with colonoscopy to detect clinically significant colorectal neoplasia and CRC. Barriers to widespread CTC implementation include the absence of a recommendation by the US Preventative Services Task Force and lack of Medicare coverage, concerns regarding radiation exposure and extracolonic findings, and the inherent difficulties involved in integrating CTC with current practice. Emerging data have demonstrated that CTC can improve CRC screening adherence and there is a current need for regulatory re-evaluation of CTC to facilitate additional gains in CRC scree...

Increasing Colorectal Cancer Screening Compliance Through Community Education

Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the nation. The incidence is especially high in the state of Louisiana, where the number of male deaths caused by colon cancer is higher than that in any other state in America. The excessive number of deaths may be attributed to decreased compliance with current screening recommendations. CRC screening, like most preventative health measures, is largely at the mercy of primary care physicians (PCPs) who must recommend or refer the patient before the preventative health measure can be completed. The project removed PCP dependence and made the patient an active participant in his or her care through a community-focused education program. The program provided instruction on CRC prevention and screening. Educational avenues used included flyer distribution, newspaper advertisements, radio advertisements, and publicly displayed posters. Patients were able to use the contact information provided to make an appointment with a provider, and insurance prerequisites, such as PCP referrals, were handled by the office staff. At the conclusion of the program, a statistical analysis showed increased compliance as a result of the educational program. A positive correlation was found between the intent of the education and the number of respondents.

An Analysis of Colorectal Cancer Screening Behavior among Overweight and Obese Participants in a National Survey

Purpose: To determine the relationship between being overweight or obese and being up-to-date with CRC screening. Methods: We used the 2007 Health Information National Trends Survey (HINTS) to evaluate participants' compliance to CRC screening guidelines for fecal occult blood test (FOBT) and endoscopy (sigmoidoscopy or colonoscopy). Our analytic cohort included 4,234 respondents without a personal history of CRC who were at least 50 years old, reported their current weights and heights and answered questions regarding their use of CRC screening modalities. We used logistic regression analyses to examine the association of being overweight or obese with being current with CRC screening (FOBT within one year, sigmoidoscopy within five years, or colonoscopy within 10 years). We used survey weights and variance estimation procedures to account for the complex survey design. We calculated odds ratios (OR) and 95% confidence interval (CI). Results: The mean age of participants was 65.1 years, 59.6% female, 81.6% white, 8.6% black, 92.8 % had health insurance and 65.9% were overweight or obese. Overall, 65.3% of participants were up-to-date with CRC screening regardless of the screening modality. After adjusting for age, sex, income, health insurance, marital status and education level, BMI was not associated with being up-to-date with CRC screening (Table).Table: Up to date with CRC screening by modalityConclusion: Colorectal cancer screening compliance does not explain the greater risk of CRC associated with being overweight or obese. Maintenance of healthy weight should be recommended for all.

An 18-gene blood-based IVD test for colorectal cancer early detection with high sensitivity and specificity.

3551 Background: Colorectal cancer (CRC) is often curable particularly diagnosed at early stages. Different screening strategies are in place in various counties. However, the compliance rate with current CRC screening recommendations remains poor. A simple blood-based IVD test would represent an interesting alternative. We previously reported a 100-gene signature for early detection of CRC using microarray technology. Based on this result, we have developed a new blood test with real-time PCR technology. Methods: 144 CRC cases and 153 Controls were enrolled. A total of 52 genes were selected as candidate markers to be transferred from microarray to real-time PCR. The gene expression profiles from 100 CRC cases and 100 Controls were used as a training set for signature discovery. Signature identification process was conducted by Minimum Redundancy Maximum Relevance (mRMR) feature selection method and Support Vector Machine (SVM) classification algorithm under the Leave-One-Out Cross Validation (LOOCV) framework. The optimal size of signature was determined by a stepwise inclusion selection procedure which started with one gene and repeatedly added genes one by one until all genes were included. The performance of each N-gene signature by the LOOCV was estimated and used to determine the best size of signature. Results: The gene expression profiles measured by microarray and real-time PCR technology were highly comparable and resulted in a significant correlation in term of fold change ratio between CRC cases and Controls (Pearson’s Correlation Coefficient = 0.95). An 18-gene signature was identified and validated in an independent validation set with 44 CRC cases and 53 Controls. The performance of 18-gene signature in the validation set reached 88.7% accuracy (95%CI: 0.80-0.94), 88.6% sensitivity (95%CI: 0.75-0.96), and 88.7% specificity (95%CI: 0.76-0.95). Conclusions: Our new results demonstrated the feasibility of technology transfer from microarray to real-time PCR. The blood test could be offered to individuals who are unwilling or unable to undergo colonoscopy to increase the CRC screening compliance rate. Meanwhile, its high specificity could also help to avoid unnecessary colonoscopies.

Sensitivity of second-generation blood-based methylated Septin9 assay for early-stage colorectal cancer.

419 Background: Early detection of colorectal cancer (CRC) has been shown to decrease mortality, although compliance to CRC screening is low. Availability of a blood-based test is expected to improve CRC screening compliance. Specific detection of CRC using the Septin9 biomarker (mSEPT9) in a large prospective trial of an average-risk CRC screening population exhibited 67% sensitivity for CRC with 88% specificity. Laboratory-developed tests detecting mSEPT9 in plasma are now available in North America and a 2nd generation molecular diagnostic blood test for mSEPT9 is available as a CE-marked kit in Europe. The current research evaluated the clinical performance of the 2nd generation mSEPT9 assay. Methods: Bisulfite-converted DNA (bisDNA) was prepared from 3.5 mL human plasma using the 2ndgeneration plasma DNA preparation kit. Resulting bisDNA was analyzed in triplicate on the ABI7500 Fast Dx (Life Technologies, Inc.) using proprietary HeavyMethyl real-time PCR technology for mSEPT9 and the 2nd generation real-time PCR kit. In a case – control design, plasma from 98 CRC patients (n = 87 stages I - III) and 99 age-matched, colonoscopy-verified normal individuals were processed with the mSEPT9 assay. In addition, plasma from 150 prospectively enrolled average risk individuals scheduled for screening colonoscopy was tested. mSEPT9 was qualitatively analyzed such that any detection of mSEPT9 in a PCR was called “positive”. Results: The revised mSEPT9 assay exhibited 95% sensitivity (95% CI: 89-98%) for CRC. Sensitivity for stage I was 89% (95% CI: 72-96%, n = 27) and sensitivity for stage II was 93% (95% CI: 78-98%, n = 29). The control group was positive at a rate of 16% (95% CI: 10-25%). Specificity of the mSEPT9 assay in the screening cohort was 85% (95% CI: 78-89%). Conclusions: The 2nd generation mSEPT9 assay demonstrated improved sensitivity for CRC without significant impact on specificity. The enhanced design and robustness of the assay will further facilitate its standardized use in routine laboratory settings. Finally, the increased sensitivity of the revised mSEPT9 assay improves the detection of early stage disease and demonstrates the feasibility of a blood-based CRC screening technology.

Aberrantly Methylated Gene Marker Levels in Stool: Effects of Demographic, Exposure, Body Mass, and Other Patient Characteristics

Background: Selected aberrantly methylated genes represent sensitive candidate stool markers for colorectal cancer (CRC) screening. We assessed the impact of demographic, exposure, body mass, and other patient variables on stool levels of highly informative methylated gene markers — BMP3, NDRG4, vimentin, and TFPI2. Methods: We studied freezer-archived stools from 500 patients with normal colonoscopy (median age 64 (range 44-85); 53% women). On supernatants from thawed aliquots, target gene sequences were purified by hybrid capture; bisulfite treated, and assayed using the analytically-sensitive QuARTS method (quantitative allele-specific real-time target and signal amplification). The reference human gene β-actin was assayed along with the 4 methylated genes. Results: Only age significantly influenced all methylated marker levels in stool (p<0.0001 for each). The relative increase per standard deviation of age was greatest with TFPI2 at 49.4% and least with BMP3 at only 0.21%; levels of β-actin did not change across age. Other demographic variables (sex, race, and residence), exposures (smoking, alcohol, or analgesic use), family or personal history of colorectal neoplasia, body mass, and diabetes mellitus had no effect on methylated marker levels. Conclusions: Although stool levels of candidate methylated markers increase with age to variable extents, most common clinical covariates have no effect. Impact: These findings have important implications on CRC screening compliance, as patients using a stool test that incorporates these markers would not have to make life-style or medication adjustments. Furthermore, age effect can be mitigated by adjustment of cut-off levels based on age or by selection of markers least influenced by age.

Factors Associated with Colorectal Cancer Screening Among Cambodians, Vietnamese, Koreans and Chinese Living in the United States

The purpose of this community-based participatory study was to identify factors associated with colorectal cancer (CRC) screening compliance and non-compliance among Cambodians, Vietnamese, Koreans and Chinese men and women 50 years and older living in the United States. A cross-sectional design was used in the study. The completed sample included 815 Asian Americans which included Cambodians (N=215), Vietnamese (N=195), Koreans (N=94) and Chinese (N=311). A 95-item questionnaire was developed and pilot tested for content validity and reliability. An in-person data collection approach was utilized and participants were given choice in responding in English or their native language. Of the 815 participants, 79.1% (N=645) reported never-screened, 7.9% (N=64), non-compliance, and 13.0% (N=106) compliance. Education was significantly associated with never-screened for CRC for Vietnamese and Chinese; employment status for Cambodians and Koreans; lack of health insurance for Cambodians, Korean and Chinese; English fluency and years lived in the U.S. for Vietnamese, Koreans, and Chinese. Less acculturated Asian Americans were more likely to be never screened, but differentially across ethnic subgroups. Barriers to screening included lack of knowledge, language, transportation, and time. Increased culturally-targeted public awareness and education programs are needed to improve CRC screening and compliance among high risk Asian American ethnic subgroups.

Comparison of compliance for colorectal cancer screening and surveillance by colonoscopy based on risk

PurposeTo compare colonoscopy screening/surveillance rates by level of risk for colorectal cancer based on age, personal history of adenomatous polyps or colorectal cancer, or family history of colorectal cancer. MethodsParticipants were aged 30–90 years, were seen within 5 years at Intermountain Healthcare, and had family history in the Utah Population Database. Colonoscopy rates were measured for those with/without risk factors. ResultsAmong those aged 60–69 years, 48.4% had colonoscopy in the last 10 years, with rates declining after age 70 years. Percentages of those having had a colonoscopy in the last 10 years generally increased by risk level from 38.5% in those with a familial relative risk <1.0 to 47.6% in those with a familial relative risk >3.0. Compared with those with no family history, the odds ratio for being screened according to guidelines was higher for those with one first-degree relative diagnosed with colorectal cancer ≥ 60 years or two affected second-degree relatives (1.54, 95% confidence interval: 1.46–1.61) than those with one affected first-degree relative diagnosed <60 years or ≥2 affected first-degree relatives (1.25, 95% confidence interval: 1.14–1.37). ConclusionsCompliance with colonoscopy guidelines was higher for those with familial risk but did not correspond with the degree of risk.

Computed Tomographic Colonography Increases Colorectal Cancer Screening Compliance

Computed Tomographic Colonography Increases Colorectal Cancer Screening Compliance

Decreased-Purgation CT Colonography: State of the Art

In the setting of CT colonography (CTC), decreasing bowel preparation measures may help to optimize colorectal cancer screening compliance without compromising accuracy. Decreased-purgation or wholly noncathartic CTC, known as nonconventional CTC, may be accomplished in conjunction with fecal tagging. Image post-processing technologies such as electronic cleansing and computer-aided detection may boost accuracy and decrease the need for bowel preparation even further. We review pre-study preparation and image post-processing techniques that have been described in nonconventional-preparation CTC studies over the past 10 years. We explore in detail specific aspects of nonconventional cathartic and fecal tagging regimens, including substance, dose, and time frame of ingestion.

Trends in Cancer Screening Among Hispanic and White Non-Hispanic Women, 2000–2005

Hispanics are the largest and fastest growing ethnic group in the United States. Compared with white non-Hispanic women, however, Hispanic women have significantly lower cancer screening rates. Programs designed to increase cancer screening rates, including the national Screen for Life campaign, which specifically promoted colorectal cancer (CRC) screening, regional educational/research programs, and state cancer control programs, have been launched. Screen for Life and some of these other intervention programs have targeted Hispanic populations by providing educational materials in Spanish in addition to English. The objective of this study was to compare changes in colorectal, breast, and cervical cancer screening rates from 2000 to 2005 among Hispanic and white non-Hispanic women, using data from the National Health Interview Survey (NHIS). The age ranges of study subjects and the definitions of cancer screening were site specific and based on the American Cancer Society (ACS) screening recommendations. Although overall screening rates were found to be lower among Hispanic women, CRC screening increased about 1.5-fold among both Hispanic and white non-Hispanic women, mainly driven by endoscopic screening, which increased 2.1-fold and 2.9-fold, respectively, from 2000 to 2005 (p < 0.01). Fecal occult blood testing (FOBT) for CRC declined among white non-Hispanic women and remained stable among Hispanic women during the same period. Mammogram and Pap smear screening tended to decline during the study period for both ethnic groups, especially white non-Hispanic women. Although cancer screening rates may be affected by multiple factors, culturally sensitive and linguistically appropriate national educational programs may have contributed to the increase in endoscopic CRC screening compliance.

Bridging the Gap: Using CT Colonography to Improve Colorectal Cancer Screening Compliance

Bridging the Gap: Using CT Colonography to Improve Colorectal Cancer Screening ComplianceDavid H. Kim1 and Judy Yee2 3Audio Available | Share

CT Colonography May Improve Colorectal Cancer Screening Compliance

While colonoscopy is currently the preferred test for colorectal cancer (CRC) screening, the invasive and time-consuming characteristics of the test are often cited as reasons for noncompliance with screening. CT colonography (CTC) is a less invasive screening method that is comparable to colonoscopy for the detection of advanced neoplasia. The aim of this project was to assess patient preferences between colonoscopy and CTC in an open access system. Two hundred fifty consecutive average-risk patients undergoing CRC screening completed a survey that assessed reasons for choosing CTC in lieu of colonoscopy, compliance with CRC screening if CTC was not offered, and which of the two tests they preferred. The most common reasons for undergoing CTC included convenience (33.6%), recommendation by referring provider (13.2%), and perceived safety (10.8%). Had CTC not been an available option, 91 of the 250 patients (36%) would have foregone CRC screening. Among the 57 patients who had experienced both procedures, 95% (n = 54) preferred CTC. These findings show the importance of providing CTC as an alternative screening option for CRC at our institution, which may increase CRC adherence screening rates.

Characteristics of Colorectal Cancer among Asian Americans

Colorectal cancer (CRC) is third in mortality rate amongst Asian Americans. However, CRC characteristics in this patient population have been poorly defined. A retrospective review at an urban tertiary hospital located in an underserved region was performed to determine CRC characteristics for Asian Americans in comparison to other races. Four hundred fourteen patients were represented by Hispanics (n=161), African Americans (n=101), Asians (n=83), and Whites (n=69). The majority of Asian American patients (n=70, 84%) presented with a left-sided lesion. This proportion was higher than that seen in African Americans (59%, P < 0.0003), Hispanics (66%, P < 0.0033), and Whites (63%, P < 0.0036). Thirty-six Asian American patients presented with Stage III disease which was the most frequent presenting stage for this patient population and also statistically higher than all the other races. Furthermore, Asian Americans in this study still presented predominantly with left-sided lesions and in a more advanced stage. These findings suggest a potential benefit of initially offering flexible sigmoidoscopy given the decreased compliance among Asian Americans to obtain routine CRC screening. Ultimately, this modality may be more acceptable, leading to higher compliance for CRC screening in Asian Americans without likely degradation in cancer detection rates.