Colorectal Cancer Screening Guidelines Research Articles

Colorectal Cancer Screening in Ghana: Physicians' Practices and Perceived Barriers.

IntroductionGhana has seen a rise in the incidence of colorectal cancer (CRC) over the past decade. In 2011, the Ghana National Cancer Steering Committee created a guideline recommending fecal occult blood testing (FOBT) for CRC screening in individuals over the age of 50. There is limited data available on current Ghanaian CRC screening trends and adherence to the established guidelines.MethodsWe conducted a survey of 39 physicians working at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. The survey evaluates physician knowledge, practice patterns, and perceived personal-, patient- and system-level barriers pertaining to CRC screening.ResultsAlmost 10% of physicians would not recommend colorectal cancer screening for asymptomatic, average risk patients who met the age inclusion criteria set forth in the national guidelines. Only 1 physician would recommend FOBT as an initial screening test for CRC. The top reasons for not recommending CRC screening with FOBT were the lack of equipment/facilities for the test (28.1%) and lack of training (18.8%). The two most commonly identified barriers to screening identified by >85% of physicians, were lack of awareness of screening/not perceiving colorectal cancer as a serious health threat (patient-level) and high screening costs/lack of insurance coverage (system-level).ConclusionDespite creation of national guidelines for CRC screening, there has been low uptake and implementation. This is due to several barriers at the physician-, patient- and system-levels including lack of resources and physician training to follow-up on positive screening results, limited monetary support and substantial gaps in knowledge at the patient level.

Socioeconomic status and colorectal cancer screening behaviors in a vulnerable multiethnic population

ABSTRACT Objective Despite some progress in recent years, colorectal cancer (CRC) screening adherence in the United States is still suboptimal, particularly among disadvantaged groups. In this study, we assessed the association between socioeconomic status (SES) and self-reported screening non-adherence (SNA) in a sample of racial/ethnic minorities living in San Francisco, California. Design/Methods A total of 376 participants of the San Francisco version of the Health Information National Trends Survey (SF-HINTS) with ages 50–75 years were included in this cross-sectional study. SNA was defined as not reporting blood stool test within the past year and not reporting sigmoidoscopy/colonoscopy within the past 10 years. Poisson regression models with robust variance estimators were used to evaluate the relation of SES with SNA, adjusting for measured confounders. Results are reported as prevalence ratios (PR) and 95% confidence intervals (95% CI). Results Overall SNA was 40%. In multivariable models including all respondents, retired participants had significantly lower SNA prevalence than employed participants (PR = 0.46, 95% CI = 0.26 0.83). In stratified analyses by race/ethnicity, Black respondents with less than high school (PR = 1.93, 95% CI = 1.09, 3.43) and those with high school or equivalent (PR = 1.88, 95% CI = 1.16, 3.04) had significantly higher SNA prevalence than those with at least some college. Among non-Hispanic Asian/Pacific Islanders, those disabled had significantly higher prevalence of SNA as compared to employed people (PR = 4.26, 95% CI = 2.11, 8.60). None of the SES indicators were significantly associated to SNA among Hispanics. Conclusions Participants with lower SES characteristics were less likely to adhere to CRC screening guidelines and being retired was a predictor of compliance. There was evidence of heterogeneity in associations between SES and CRC screening by race/ethnicity. Life circumstances of retired people could provide insights for designing interventions aimed to improve CRC screening uptake in these priority groups. Future efforts should consider mechanisms underlying differences by race/ethnicity.

Effects of family health history-based colorectal cancer prevention education among non-adherent Chinese Americans to colorectal cancer screening guidelines

ObjectiveThis study examined the effects of the first family health history (FHH)-based colorectal cancer (CRC) prevention education on 1) FHH of CRC communication with family members and primary care physicians (PCPs), 2) fecal occult blood test (FOBT) uptake, and 3) CRC preventive lifestyle modifications among 50- to 75-year-old Chinese Americans non-adherent to CRC screening guidelines. MethodsUsing a community–based participatory research approach, we developed and implemented 62 culturally and linguistically appropriate, theory-driven, FHH-based CRC prevention educational workshops across Texas for 344 Chinese Americans (mostly with low education/income) aged 50–75 years who were non-adherent to CRC screening guidelines. ResultsLinear mixed modeling analyses showed that participants’ FHH of CRC communication with PCPs and family members significantly increased two-week post-workshop compared to pre-workshop data (ps<0.001). Moreover, at two-weeks post-workshop, 91.9 % of participants underwent FOBT. Nevertheless, no significant changes were found in participants’ lifestyles. ConclusionOur educational workshops successfully increased Chinese Americans’ FHH of CRC communication and FOBT uptake. Personalized education with longer follow-ups may be needed in future studies to promote lifestyle changes among Chinese Americans. Practice implicationsHealth and public health professionals may adopt our workshop educational materials to provide patient and public CRC prevention education for Chinese Americans.

The impact of social determinants on receipt of colonoscopy in an under-resourced hospital service area: A retrospective cohort study.

216 Background: Although colorectal cancer (CRC) screening with colonoscopy reduces the risk of CRC mortality, screening rates remain low among African Americans and low social economic status (SES) patients. However, few studies have assessed CRC screening rates in under-resourced hospital service areas. Using a granular measure of socioeconomic deprivation (SED), we examined the association between social determinants and CRC screening. Methods: We conducted a retrospective cohort study from 2014-2019 to identify primary care patients referred for CRC screening with colonoscopy at an academic hospital system. Patients were assessed at annual visits for completion of colonoscopy. SED was assessed using the area deprivation index (ADI), a composite measure of 17 SED indicators including income, housing, education, and employment at the census block group level. Other social determinants analyzed were race and insurance status. Frequency and multivariable logistic regression were used for statistical analysis. Results: 1040 patients met CRC screening guidelines and were referred for colonoscopy. 136 (13.1%) underwent colonoscopy in the follow-up period. High and low SED made up 655 (63%) and 77 (7.4%) of patients, respectively. SED, race, age, and sex were not associated with higher screening rates. Uninsured patients had a lower rate of screening. After controlling for other social determinants, uninsured patients had the lowest odds of colonoscopy (OR 0.28; 95% CI, 0.08-0.92). Conclusions: In this under-resourced hospital service area, receipt of colonoscopy for CRC screening is significantly lower than previously reported. Furthermore, screening rates were persistently low across strata of SED, race and insurance status, with uninsured patients having the lowest odds of screening. These data suggest that in an under-resourced hospital service area with extensive SED, further research is needed to understand the role of social determinants and behavioral factors to address disparities in CRC screening with colonoscopy. [Table: see text]

S0285 Improving the Rate of Colorectal Cancer Screening in the Outpatient Clinic

INTRODUCTION: While colonoscopy remains the gold standard for colorectal cancer (CRC) screening, in 2016 in the United States only 67.3% of eligible adults were screened for CRC, despite multiple studies showing a 68%–88% reduction in CRC mortality in patients receiving CRC screening. With roughly 147,950 new cases expected to be diagnosed in 2020 with a subsequent 53,200 deaths, we created a quality improvement initiative to determine if physician education could have a significant impact on increasing CRC screening adherence in the outpatient setting. METHODS: We queried our electronic medical record to harvest the number of patients who qualified for screening colonoscopy, with an average risk for colon cancer (i.e., those without a family history of colorectal neoplasia). From January 2018 through January 2019, a total of 1777 patients over ten residency cohorts at two different locations were found to be eligible CRC screening, we calculated the rate of completed CRC screening amongst these patients. This was calculated as the percentage of patients with either a colonoscopy within the past 10 years, or a flexible sigmoidoscopy over the last 5 years, or a fecal occult blood testing over the last year. Physician education interventions were performed in January 2019. Our educational interventions included an academic day focused on the American College of Gastroenterology (ACG) CRC screening guidelines, the importance of CRC screening, and the percentage of completed CRC screenings per residency cohort over the past year. We then calculated the difference in percentages of completed CRC screenings by each of the ten residency cohorts before and after physician education from January 2019 to June 2019. RESULTS: Our results show that physician education increased the percentage of completed CRC screening in the outpatient resident clinics overall. Individual Cohort data can be seen in Figures 1 and 2. Figures 1 and 2 show the percent change from baseline for each residency outpatient clinic cohort at two resident clinic sites, Clinic #1, and Clinic #2, respectively. CONCLUSION: Our study shows that physician education may have an impact on increasing CRC screening percentages in the outpatient setting, despite patient factors. We recommend physician education on the importance of CRC screening, the ACG guidelines for CRC screening, and the percentages of eligible patients who go unscreened.Figure 1.: Shows the percentage improvement in each of the 5 Clinic #1 cohorts. Cohort E showed the most significant results, improving 13.3%. Cohorts A-D also showed positive results, ranging from 0.4% to 3.9%.Figure 2.: Shows the increase in the percentage of CRC screening for each of the 5 Clinic #2 cohorts. Cohorts B-D all showed positive results ranging from 6.4% to 9.6%, while Cohorts A and E showed negative results at −6.9% and −1.9%, respectively.

Reigniting Colorectal Cancer Screening as Communities Respond to the COVID-19 Pandemic

This presentation will summarize current guidelines for colorectal cancer (CRC) screening and an expert consensus document designed to assist primary care providers and health systems with the resumption of screening for CRC during the COVID-19 pandemic. The tool, an action-oriented playbook, aims to align clinicians (particularly primary care providers and endoscopists), health systems, public health professionals and CRC screening advocates across the nation to work together to reignite our screening efforts appropriately, safely, and equally for all communities. The COVID-19 pandemic has magnified pre-existing inequities in CRC screening and outcomes, hindering the progress toward the national goal of an 80% CRC screening rate in every community. In the early stages of the COVID-19 pandemic leading agencies, such as the Centers for Medicare & Medicaid Services and the American Cancer Society, made recommendations to delay all non-urgent procedures. Colonoscopies have been delayed or cancelled and patient fears about contracting COVID-19 have led to further reductions in screening. This drop has raised concern that COVID-19 related screening delays will lead to missed and advanced stage CRC diagnoses and to excess deaths. Moreover, this burden will likely not be evenly distributed as screening disparities may be exacerbated in communities and populations that are disadvantaged by both old and new challenges in the COVID-19 era. This presentation offers data, research, and clinical guidelines related to CRC screening and COVID-19 to enable the CRC fighting community to stand prepared and well-positioned to respond to and overcome the difficult task ahead.

NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020.

The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel's recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.

A National Survey of Adoption of the 2018 American Cancer Society Colorectal Cancer Screening Guideline in Primary Care

Recent data have shown increasing incidence of colorectal cancer (CRC) among those younger than 50 years of age.1,2 In response, the American Cancer Society (ACS) introduced new guidelines in May 2018 that recommend initiation of CRC screening in average-risk adults at age 45, which is 5 years earlier than existing recommendations from the US Preventive Services Task Force and US Multi-Society Task Force on Colorectal Cancer.3-5 Most screening colonoscopies are ordered directly by primary care providers (PCPs) via "direct" or "open.

Right sided colorectal cancer increases with age and screening should be tailored to reflect this: a national cancer database study.

In the United States, colorectal cancer (CRC) screening and surveillance is recommended until age 75. However, rates of surgery for CRC are greatest in the elderly, questioning current guidelines. Tumor sidedness is an emerging prognostic marker that may help guide screening and treatment decisions, with specific benefit evaluating CRC anatomic distribution in the elderly. Our objective was to investigate the anatomical distribution of CRC in the elderly and factors associated with right-sidedness. The National Cancer Database (2004-2016) was used to identify elderly patients with CRC. Cases were stratified by tumor sidedness and elderly subgroups: 65-74, 75-84, and ≥ 85years of age, and further categorized by primary site. Multivariate analysis identified factors associated with CRC right-sidedness. The outcomes were CRC sidedness in the elderly, the anatomic distribution by age group, and factors associated with right-sidedness. There were 508,219 colorectal cancer patients aged over 65years identified, 54% of whom had a right-sided cancer. The right-sided incidence rates by age group were 49% (65-74years), 58.2% (75-84years), and 65.9% (≥ 85years) (p < 0.001). Variables associated with right-sidedness were age (OR 1.032; 95% CI 1.031-1.033; p < 0.001), female sex (OR 1.541; 95% CI 1.522-1.561; p < 0.001), Medicare (OR 1.023, 95% CI 1.003-1.043; p = 0.027), year of diagnosis ≥ 2010 (OR 1.133; 95% CI 1.119-1.147; p < 0.001), tumor size > 5cm (OR 1.474; 95% CI 1.453-1.495; p < 0.001), pathologic stage IV (OR 1.036; 95% CI 1.012-1.060; p = 0.003). We found higher rates of right-sided colon cancer in the 75 and above age group. This is a population who would benefit greatly from a high-quality and complete colonoscopy for early diagnosis. As screening and surveillance for this age group are not currently recommended, our findings question the lack of universal recommendation of colonoscopy in patients over 75years old. Guidelines for CRC screening and surveillance should consider the colon cancer right-shift in the elderly population. Based on these results, we recommend thorough assessment of the proximal colon in the elderly.

Impact of Health Insurance, Poverty, and Comorbidities on Colorectal Cancer Screening: Insights from the Medical Expenditure Panel Survey.

Despite national campaigns and other efforts to improve colorectal cancer (CRC) screening, participation rates remain below targets set by expert panels. We hypothesized that availability and practice patterns of healthcare providers may contribute to this gap. Using data of the Medical Expenditure Panel Survey for the years between 2000 and 2016, we extracted demographic, socioeconomic, and health-related data as well as reported experiences about barriers to care, correlating results with answers about recent participation in colorectal cancer screening. As CRC screening guidelines recommend initiation of testing at age 50, we focused on adults 50years or older. We included responses of 163,564 participants for the period studied. There was a significant increase in CRC screening rates over time. Comorbidity burden, poverty, race, and ethnicity independently predicted participation in screening. Lack of insurance coverage and cost of care played an important role as reported barrier. Convenient access to care, represented by availability of appointments beyond typical business hours, and frequency of provider interactions, correlated with higher rates of screening. Our data show a positive effect of educational efforts and healthcare reform with coverage of screening. Easy and more frequent access to individual providers predicted a higher likelihood of completed screening tests. This finding could translate into more widespread implementation of screening programs, as the increasingly common virtual care delivery offers a new and convenient option to patients.

A Collaborative Survey of Nurse Practitioner Colorectal Cancer Screening Practice

Colorectal cancer (CRC) is the second leading cause of cancer death in men and women in the United States. The opportunity for nurse practitioners (NPs) to initiate preventive measures to guide early detection of CRC is great given its slow progression. We present a collaborative project between a state NP association and colleagues from the Medical Affairs Division of a pharmaceutical company to develop an electronic survey to assess NP knowledge, beliefs, and practice patterns for CRC screening. Survey data identified that NP knowledge of CRC screening guidelines is variable and may contribute to low screening rates.

Colorectal Neoplasia among Patients with and without Human Immunodeficiency Virus.

Increasing availability of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) has led to prolonged survival and rising incidence of non-HIV-defining cancers among patients with HIV. Compared with the general population, risk of colorectal cancer may differ among those with HIV due to immunosuppression, oncogenic viral coinfections, and higher prevalence of risk factors. We identified patients (age ≥50 years) diagnosed with HIV, prescribed HAART for ≥6 months, and receiving care in two large health care systems in Dallas, TX. Patients received a first colonoscopy between January 2009 and December 2017. We calculated a standardized prevalence ratio as the ratio of observed to expected number of advanced neoplasia (high-risk adenoma or colorectal cancer) using an age- and sex-matched cohort of patients without HIV (n = 10,250). Among patients with HIV (n = 839), about two thirds (60.1%) had normal findings at colonoscopy; 6.8% had hyperplastic polyps only, 20.4% had low-risk adenomas, 11.7% had high-risk adenomas, and 1.1% had colorectal cancer. Prevalence of advanced neoplasia was similar between patients with and without HIV, with a standardized prevalence ratio of 0.99 (95% confidence interval, 0.81-1.19). There was no difference in the prevalence of colorectal neoplasia between patients with and without HIV. Patients with HIV appear to have similar risk of colorectal neoplasia compared to those without HIV and can therefore follow average-risk colorectal cancer screening guidelines.

Screening For Colorectal Cancer in the Age of Simulation Models: A Historical Lens

Screening For Colorectal Cancer in the Age of Simulation Models: A Historical Lens

Fecal Occult Blood Tests in Colorectal Cancer Screening: Systematic Review and Meta-analysis of Traditional and New-generation Fecal Immunochemical Tests.

Noninvasive fecal occult blood tests (FOBTs) are recommended by current guidelines for colorectal cancer (CRC) screening. Our aim was to assess the diagnostic performance of traditional guaiac-based FOBTs (gFOBT) and new-generation immunochemical FOBTs (iFOBT) in CRC screening by carrying out a systematic review and meta-analysis. PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible articles published before February 17, 2020. Three independent investigators conducted study assessment and data extraction. Diagnosis-related indicators for use of FOBTs in the detection of CRC (as the endpoint) in a screening setting were summarized, and further stratified by the type of FOBT (gFOBT vs. iFOBT). STATA software was used to conduct the meta-analysis. Pooled sensitivities and specificities were calculated using a random-effects model. Hierarchical summary receiver operating characteristic curves were plotted and area under the curves (AUC) were calculated. The electronic search identified 573 records after duplicates were removed, of which 75 full-text articles were assessed for eligibility. Finally, a total of 31 studies were eligible for the meta-analysis. In the ROC comparison test, there was a statistically significant difference in the performance of gFOBT and iFOBT tests, with AUC=0.77 (95% confidence intervaI=0.75-0.79) and AUC=0.87 (95% confidence intervaI=0.85-0.88), respectively (p=0.0017). In formal meta-regression, test brand did not prove to be a significant study-level covariate that would explain the observed heterogeneity between the studies. New-generation iFOBTs were found to have a significantly higher diagnostic performance as compared with gFOBTs, advocating the use of only fecal immunochemical tests in all newly implemented CRC screening programs.

P-191 Optimal age to start screening for colorectal cancer in average-risk adults: 50 or 45 years old?

According to current international colorectal cancer (CRC) screening guidelines, regular screening for CRC should start at 50 years of age in average-risk adults. Recent epidemiological data show constantly increasing incidence of CRC in patients of younger age, which led the American Cancer Society to issue a guideline suggesting that regular screening for colorectal cancer should start at 45 years of age (American Cancer Society, qualified recommendation). The aim of the study was to compare the screening colonoscopy findings in 3 different age groups (40-44, 45-49, 50-54 years) in a Greek referral centre. We retrospectively studied people of 40 to 54 years old who underwent colonoscopy screening with high definition endoscopes during the last 2 years in the Endoscopy Unit of the Gastroenterology Department. High-risk patients were excluded (polyposis syndrome, positive family history for colon cancer, inflammatory bowel disease), as well as symptomatic patients (with the exception of irritable bowel syndrome symptoms) and those with inadequate bowel preparation. Sex, age, endoscopic findings (cancer, advanced adenomas, any adenomas, serrated polyps, localization) and bowel preparation (Boston Bowel Preparation Scale) were registered. From November 2016 to December 2019 a total of 411 patients (282 female) were assessed: 40 patients aged 40-44, 110 patients aged 45-49, and 261 patients aged 50-54. The bowel preparation was characterized as excellent in 63.3% of the patients, average in 5,1% and good in the remaining. The overall adenoma detection percentage was 18.6% for men and 6.5% for women. No cancers were reported. The percentage of findings for every age group respectively were for advanced adenomas 0%, 6.5% and 1.9%, for any adenomas 2.5%, 13% and 10.4%, for serrated polyps 0%, 1.9% and 2.7% and for isolated right colon adenomas 0%, 23.1% and 33.3%. No significant statistical difference was found in the comparison between age groups. Logistic regression analysis showed that adenomas were 3.3 times more frequent in male patients. No statistically significant differences were detected, especially between age groups 45-49 and 50-54 years. Notably, there was a very low percentage of findings in the age group 40-44 years. Interestingly female patients were more prone to undergo screening colonoscopy, while they presented with a 70% lower probability of finding adenomas compared to male patients. The topic of starting regular screening colonoscopy at 45 years of age remains under discussion.

Abstract B004: Capacity development among patient navigators to enhance colorectal cancer control in American Indian-serving healthcare facilities in the U.S. Southwest and Southern Plains

Abstract According to the Institute of Medicine’s National Cancer Policy Forum, the American Cancer Society, and the National Cancer Institute, cancer screening programs are partly responsible for declining colorectal cancer (CRC) incidence and mortality rates in the U.S. Unfortunately, American Indians (AIs) have experienced either no change or an increase in CRC incidence and mortality, disproportionate diagnosis of late stage disease and poorer survival. While, nearly two-thirds of U.S. adults are current with United States Preventive Services Task Force (USPSTF) guidelines for CRC screening, AI screening rates range from only 28% to 51% in the Southwest and Southern Plains regions. One evidence-based intervention strategy for increasing CRC screening recommended by the Community Preventive Services Task Force (CPSTF) is patient navigation. By offering interpretation, transportation, social support, and culturally and linguistically appropriate education and outreach, patient navigators are able to reduce structural barriers and facilitate access to screening. While researchers have documented effectiveness of patient navigation towards enhancing cancer screening among AI populations, few studies have elucidated best practices for training patient navigators to serve in this capacity. As an effort of the AI CRC Screening Consortium formed by the National Cancer Institute-Designated Cancer Centers at the Universities of Arizona, New Mexico, and Oklahoma, we trained a cadre of 21 individuals to serve as patients navigators in six unique AI-serving health clinics and communities in Oklahoma, Arizona, and New Mexico. We used a unique blend of didactic and interactive training components (i.e. role playing, games, and group dialogues). The 2.5-day curriculum centered upon a set of nine modules that included digestive system anatomy, USPSTF CRC screening guidelines, stool-based test procedures, direct visualization test procedures, CRC risk factors, CRC diagnosis and treatment, Transtheoretical Model and Motivational Interviewing, and patient navigation tips. A 36-item pre-/post-test was administered to assess the impact of training upon navigator capacity. Paired-sample t-tests were utilized to analyze mean differences in scales measuring two key constructs – CRC-specific knowledge and self-efficacy to engage in CRC control efforts. Evaluation findings demonstrated statistically significance increases in both CRC knowledge scores (pre-test mean = 7.8/12.0 vs. post-test mean 10.9/12.0, p=0.000) and self-efficacy scores (pre-test mean = 3.8/5.0 vs. post-test mean = 4.8/5.0, p=0.001). These findings demonstrate the value of robust capacity development activities with patient navigators prior to intervention as a means of not only increase knowledge about CRC and its associated screenings, but to also engender significant readiness and confidence among patient navigators to integrate CRC control into practice. Citation Format: Kevin C English, Cheyenne Jim, Jennifer Hatcher, Mark P Doescher, Shiraz I Mishra, Peter Lance, Dorothy Rhoades, Usha Menon. Capacity development among patient navigators to enhance colorectal cancer control in American Indian-serving healthcare facilities in the U.S. Southwest and Southern Plains [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 B004.

Abstract B017: Rural interventions for screening effectiveness: Baseline cancer screening behaviors of rural women of Indiana and Ohio

Abstract Rural areas of the United States experience increased cancer incidence and mortality rates and lower cancer screening rates compared to urban areas. According to the National Center for Health Statistics, Ohio and Indiana are ranked 8th and 10th highest, respectively, for cancer mortality rates nationally. The Rural Interventions for Screening Effectiveness (RISE) Study conducted by The Ohio State University and Indiana University focuses on improving breast, cervical and colorectal cancer screening rates in rural areas of both states to reduce this cancer burden. RISE is testing two interventions to educate and encourage women in rural counties of Ohio and Indiana ages 50-74 years to complete any needed screenings. Participants complete baseline and 12-month surveys and receive usual care brochures, an interactive DVD, or the DVD along with phone-based assistance from a patient navigator. In order to be eligible to participate, women must be residents of a rural county of either state, outside of guidelines for breast, cervical, and/or colorectal cancer screening per medical record review, and have no personal history of inflammatory bowel disease, cancer (except non-melanoma skin cancer), or genetic conditions that increase cancer risk. Baseline demographic and cancer screening history data were collected from 1634 women (1041 Ohio, 593 Indiana), and 985 were ultimately eligible and enrolled in the study (599 Ohio, 386 Indiana). Women who were within guidelines for all three screening tests were excluded from the study; 442 (42.5%) in Ohio and 207 (34.9%) in Indiana. A larger proportion of Indiana women were outside of guidelines for all three screening tests (80 of 593 (13.5%)) compared to Ohio women (107 of 1041 (10.3%)). Across both states, more women were adherent to breast cancer screening guidelines (75.3%) than cervical (66%) or colorectal cancer screening guidelines (58.8%). A comparison of screening behaviors of Indiana and Ohio participants will be conducted to determine if differences between the two exist. Analyses will focus on being inside or outside of guidelines by individual test (breast, cervical, and colorectal) and all three tests combined. Although rural women of Midwest states are often considered to be very similar, differences in screening behaviors exist, even between women of neighboring states, and future efforts to improve the cancer burden in rural women could benefit from considering factors that contribute to these differences, such as access to quality care. Citation Format: Electra D Paskett, Ryan D Baltic, Mira L Katz, Gregory S Young, Susan Rawl, Victoria Champion. Rural interventions for screening effectiveness: Baseline cancer screening behaviors of rural women of Indiana and Ohio [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 B017.

Abstract C120: Evidence-based strategies to enhance colorectal cancer screening in American Indian communities

Abstract Despite the proven effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have some of the lowest CRC screening rates. Nearly two-thirds of US adults are current with US Preventive Services Task Force guidelines for CRC screening. In contrast, based on Indian Health Service (IHS) Government Performance and Results Act (GPRA) data, AI screening rates range from a low of 28% in the Phoenix Area, to 30% in the Albuquerque Area and a high of only 51% in the Oklahoma Area. The AI CRC Screening Consortium was formed by the National Cancer Institute-Designated Cancer Centers at the Universities of Arizona, New Mexico, and Oklahoma to address the major regional CRC screening disparities. The Consortium’s overall objective is to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC through the implementation of cost-effective multilevel, multicomponent evidence-based interventions (EBIs) across AI populations (on and off tribal lands) in the tri-state region. As part of the planning phase of the project (Year 1), we completed mixed-methods environmental scans (focus group and interviews, and readiness to change surveys) among tribal members and multisector healthcare providers practicing at Indian Health Service (IHS, I), Tribal (T), and Urban Indian (U) (I/T/U) healthcare facilities across the three states. In all, we conducted seven focus groups, 71 interviews, and three surveys at nine I/T/U healthcare facilities. We organized the focus group and interview data according to The Guide to Community Preventive Services (The Community Guide) recommendations for strategies to increase: community demand, community access, and provider delivery of CRC screening. We will provide quotes and summaries underscoring the EBIs and strategies recommended by the multisector healthcare action teams for implementation at their healthcare facilities. We will also describe the establishment of the Consortium and challenges experienced in conducting research with multiple tribal and federal entities and regulatory authorities. The use of community-academic participatory approaches has facilitated bidirectional and mutually beneficial knowledge integration, collaborative inter-dependent partnerships, equity in data ownership, and capacity enhancement. The scope of this project presents an opportunity to reduce CRC incidence and mortality affecting thousands of AIs. Our collaborative work will create opportunities for future research addressing the spectrum of CRC prevention, detection, and treatment in AI populations across the US. Citation Format: Shiraz I Mishra, Mark P Doescher, Jennifer Hatcher, Kevin English, Dorothy Rhoades, Peter Lance, Shane Pankratz, Jessica Blanchard, Nicholas Edwardson, Michelle Hopkins, Andrew Sussman, Zsolt Nagykaldi, Cheyenne Jim. Evidence-based strategies to enhance colorectal cancer screening in American Indian communities [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 C120.

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.

Colorectal cancer: Improving screening in rural clinic.

e19215 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. From 2010 to 2014, CRC was also the second leading cause of cancer deaths in North Carolina (NC). Between 2012-2016, the age adjusted mortality rate was 18-25 per 100,000 persons in Robeson County, NC. During this timeframe, it is estimated that if all people aged 50 and older in NC were routinely screened, 40 out of 100 deaths from late stage CRC can be prevented. A chart review in a rural primary care clinic identified patients not being appropriately screened for targeted intervention. Methods: Retrospective chart review at Lumberton Medical Clinic, a rural outpatient Internal Medicine Clinic, reviewed 1622 records from adults 50-75 years old during the timeframe September 2017 - August 2018 for phase I and 1588 records from September 2018-August 2019 for phase II. Patients with history of CRC or status-post colectomy for other reasons were excluded from this study. Patient records were assessed for compliance with USPTF CRC screening guidelines – adults aged 50 to 75 years receive screening as follows: 1) Fecal occult blood testing (FOBT) annually 2) Flexible sigmoidoscopy every 5 years 3) Colonoscopy every 10 years OR 4) Combined FOBT (every 3 years) + flexible sigmoidoscopy (every 5 years). Following data analysis in phase I, interventions to increase screening rates were initiated – provider education, posters hung in exam rooms, and individualized letters mailed to patients found deficient. The success of this effort was measured in phase II. Results: For phase I, the review showed 56% of patients received appropriate screening and 44% were found with no documentation of screening. Following interventions, 76% received appropriate screening and 24% with no documentation. Thus, there is ~35% improvement in screening rate. Conclusions: The mortality rate from CRC is higher in Robeson County compared to the NC state rate. Additionally, 40% of deaths from late-stage CRC may be prevented by doing a routine screening. It is the responsibility of providers to emphasize the importance of proper screening. This retrospective review showed ~ 35% improvement in screening rates following interventions. The result might not be as high as expected due to several factors: 1) new resident physicians and faculty 2) few posters were taking down due to disagreement with the guidelines by one of the 3 main providers 3) patients might not receive the letters. To further increase the screening rate, we are implementing the “Preventive Maintenance” tab in our electronic medical record system at the end of clinic visits.