Importance Of Colorectal Cancer Screening Research Articles

Risk factors for colorectal cancer in a fecal immunochemical test-positive group: The National Health Insurance Service-National Health Screening Cohort.

Colorectal cancer (CRC) was the fourth most common cancer in Republic of Korea in 2019. It has a gradually increasing mortality rate, indicating the importance of screening for CRC. Among the various CRC screening test, fecal immunochemical test (FIT) is a simple yet most commonly used. Neverthelss, there have been only few long-term studies on subjects with FIT-positive. Therefore, in this study, we aimed to investigate the risk factors for CRC in FIT-positive patients using the National Health Insurance Service Bigdata database. Among 1737633 individuals with a FIT screening result for CRC in 2009, 101143 (5.82%) were confirmed to be FIT positive. The CRC incidence over 10years (up to 2018) of these participants was investigated using the National Cancer Registry. Out of the 101143 FIT-positive participants, 4395 (4.35%) were diagnosed with CRC. The FIT-positive patients who underwent a second round of screening showed a 5-year cumulative CRC incidence of approximately 1.25%, whereas those who did not showed an incidence of approximately 3.75%. Among the FIT-positive patients, the CRC incidence in the non-compliance group for the second round of screening was 2.8 times higher than that in the compliance group. In FIT-positive participants, non-compliance with the second round of screening was identified as a major risk factor for CRC development. It is necessary to establish appropriate strategies for managing risk factors for CRC in FIT-positive patients to increase the rate of compliance with the second round of CRC screening.

Abstract A100: Associations of multiple chronic conditions and colonoscopy utilization among different race/ethnic groups: BRFSS 2012-2020

Abstract Background: Colorectal cancer (CRC) is the 4th most commonly diagnosed cancer and the 4th cause of cancer-related death in the U.S. Early detection of CRC through routine screening has been associated with decreasing CRC mortality. Because many chronic conditions share risk factors with CRC, the importance of CRC screening in adults with multiple chronic conditions (MCC) is increased as those with MCC are at higher risk of developing CRC. This study examines the association of number and types of chronic conditions (individual, dyads, and triads) with the receipt of colonoscopy and whether this association differs across race/ethnic groups. Methods: We conducted a cross-sectional analysis of 976,467 adults aged 50-74 years in the US Behavioral Risk Factor Surveillance System (2012-2020). Self-reported receipt of last/most recent colonoscopy was categorized as never, <10 years and ≥10 years. MCC was calculated using counts of 12 chronic conditions (obesity, arthritis, diabetes, smoking, depression, binge drinking, cardiovascular diseases (CVD), asthma, chronic obstructive pulmonary disease (COPD), kidney disease, cancer, skin cancer) and categorized as none, 1, 2, ≥3 conditions. The most common chronic condition dyads and triads were assessed. A logistic model was used to quantify the association between MCC and the receipt of colonoscopy adjusted for sex, age, and health care insurance status; additional analyses were stratified by race/ethnicity. All results were weighted to be representative of the broader population of U.S. adults aged 50 – 74 years using standard BRFSS weights. Results: Over half the sample were women (52.5%), 72.4% non-Hispanic white, and 62.8% had a colonoscopy in previous 10 years. Nearly one-third had ≥3 MCC (32.6%) and 23.1% had two MCC. Participants with ≥3 MCC were more likely to have had a colonoscopy in ≤10 years (adjusted odds ratio [aOR]: 1.28; 95% confidence interval [CI]: 1.24–1.32) than those without MCCs, regardless of race/ethnicity. Participants with the triad of smoking, binge drinking, and CVD were less likely to have had a colonoscopy within 10 years (aOR: 0.65; 95%CI: 0.54–0.78) than those without this MCC triad. The association between different combinations of MCC and colonoscopy utilization varied by race/ethnicity. Among those with the smoking/binge drinking/CVD triad, non-Hispanic Blacks (aOR: 0.59; 95%CI: 0.39–0.90) and US Hispanics (aOR: 0.28; 95%CI: 0.10–0.74) participants were less likely to have had a colonoscopy within 10 years than participants without this triad and identified with the same race/ethnic group. Conclusion: MCCs are common among adults aged 50-74 years. The MCC triad of smoking, binge drinking, and CVD was associated with a lack of colonoscopy adherence recommendation, and adults identified as non-Hispanic Blacks and US Hispanics with this triad were even less likely to receive a colonoscopy within 10 years. This finding may help health care providers and systems to identify patients at higher risk of CRC and non-adherent to cancer screening recommendations. Citation Format: Maira A. Castaneda-Avila, Mara M. Epstein, Mayra Tisminetzky, Atinuke G. Oyinbo, Kate L. Lapane. Associations of multiple chronic conditions and colonoscopy utilization among different race/ethnic groups: BRFSS 2012-2020 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A100.

S331 The Impact of PCP Counseling for Colorectal Cancer Screening: A Primary Care Quality Improvement Project

Introduction: Effective primary care physician (PCP) counseling plays a key role in patient adherence to primary prevention cancer screening programs. The impact of PCP counseling on the patients’ adherence to colorectal cancer (CRC) screening programs is believed to be underestimated. Therefore, we conducted a 24-week prospective quality improvement initiative investigating the effects of PCP counseling for CRC screening on patient participation rates. Methods: We identified patients who met the criteria for CRC screening during their routine primary care appointments at the resident-run internal medicine ambulatory clinic at Cleveland Clinic (CCF) from October 2021 to March 2022. A fishbone diagram was used for root-cause analysis which revealed key causes of inadequate CRC screening: lack of patient education and awareness about the importance of CRC screening. Our PDSA cycle included patient education by PCPs about the importance of CRC screening in asymptomatic patients and the benefits of early treatment of the disease. The PCPs explained various screening modalities. The chosen modality was ordered for interested patients. The primary outcomes were the percentage of patients who agreed to undergo CRC screening and the percentage of patients who scheduled or completed the screening test. Results: A total of 52 subjects both met the criteria for CRC screening and attended their routine primary care appointments at CCF where they underwent PCP counseling. Only 4 (8%) patients had undergone a prior CRC screening test. The median age was 55 years, and females compromised 52% of the subjects. A total of 44 subjects (85%) agreed to undergo CRC screening after being counseled by their PCPs. Of those 44 individuals, 42 (95%) chose colonoscopy, and two (5%) chose FOBT. By the end of the study period, eighteen patients (41%) had either scheduled or completed their tests (Figure, Table). Conclusion: Our study demonstrates that PCP counseling is associated with high patient engagement to undergo CRC screening. However, it is still unclear whether PCP counseling in the context of a primary care clinic visit alone is sufficient to ensure the completion of CRC screening. Thus, we plan to examine CRC screening completion rates within a year of the original test being ordered and explore barriers that limit the completion of CRC screening by surveying patients in subsequent clinic visits. We will propose other interventions (email reminders or phone calls) to address these barriers and improve CRC screening completion rates.Figure 1.: Time course of patients who agreed to undergo CRC screening. Table 1. - Summary of the data Age median (range) 55 (45-83) yrs Female vs. Male 52.0% vs 48.0% Percentage of patients were up to date with CRC screening 8.0% Percentage of patients who agreed to undergo CRC screening 85.0% Percentage of patients who scheduled their CRC screening test by the time of data curation 41.0%

S2230 A Unique Case of Rectal Adenocarcinoma Presenting as Headache

Introduction: Colorectal cancers occur when cells lining the colon and rectum become hyperproliferative and grow out of control. Symptoms of colorectal cancer often do not appear until cancer has advanced, therefore it is important to have timely colon cancer screening. Brain metastases from colorectal carcinoma are a rare entity and we present one such case. Case Description/Methods: The patient is a 27-year-old gentleman with a past medical history significant for irritable bowel syndrome who presented to the emergency room, with complaints of unilateral frontal headache and bloody bowel movements. The patient started experiencing right-sided frontal headache 2 weeks before the presentation which was associated with blurry vision and nausea. The patient also endorsed having multiple episodes of bloody bowel movements associated with rectal pain and tenesmus. The patient also endorsed losing 50 pounds in the last 2 months, which was unintentional, and associated with appetite loss and generalized weakness. On physical examination, the patient was alert, oriented times 3, and had no focal neurological deficits. A CT scan of the head was done which revealed 3x2x3 cms sized oval-shaped isointense mass with cerebral edema and 1 cm midline shift. A CT scan of the abdomen and pelvis was also done which showed the presence of a heterogeneous appearing soft tissue density lesion in the right anterolateral wall of the rectum measuring 2.7x3.9x7.1 cms. The neurosurgery team was consulted and the patient was started on steroids and seizure prophylaxis medication. The patient underwent a craniotomy for intracranial neoplasm excision. The excised mass was sent for pathology which resulted as metastatic adenocarcinoma of colorectal origin. The patient tolerated the procedure well and was referred to oncology and gastroenterology for further management. The patient is scheduled to get a colonoscopy and is about to be initiated on chemotherapy as well (Figure). Discussion: Colorectal cancer is one of the leading causes of death due to cancer in the United States. In general colorectal cancer, metastasize to the liver and lungs, and metastases to the brain are rare. Aggressive surgical resection in selected patients shows improved survival rates and better prognosis. As clinicians, we must be aware of unique presentations of colorectal carcinoma and the importance of colorectal cancer screening. Raising awareness about colorectal carcinoma amongst the general population is of utmost importance.Figure 1.: Ct scan images and Histopathology slides.

A Retrospective Study From a Single Center in Romania of 36 Patients Aged Between 37 and 59 Years Who Presented With Locally Advanced Colorectal Cancer.

BackgroundThe incidence of colorectal carcinoma is increasing in younger adults. This retrospective study was conducted at a single center in Romania and included 36 patients aged between 37 and 59 years who presented with locally advanced colorectal cancer. The purpose of this study is to show the importance of colorectal cancer screening in young patients.Materials and methodsThe study included 36 patients with histologically proven colorectal cancer evaluated in OncoFort Hospital. Disease staging was based on surgical findings and pre or post-operative abdominal CT or MRI of the abdomen and pelvis. The inclusion criteria were defined as a history of adjuvant chemotherapy plus radiotherapy and whether one had locally advanced colorectal cancer or recurrent or metastatic disease.ResultsOf the 36 patients, 13 (36.11%) were women, and 23 (63.8%) were men. The mean age was 47.4 years (range: 37-59 years). The colon cancers were more frequent than tumours of the rectum (n = 19, 52.77% versus n = 17, 47.23%). A total of 44.44% of patients were classified as stage III-IV. We found no significant correlation between mutation status or histologic grade and age. ConclusionThis real-world study from a single center in Romania highlights that colorectal carcinoma may present in advanced stages in younger patients and may support consideration of a need to perform further studies to determine if the current age recommendations for screening should be lowered.

Effect of a family-based multimedia intervention on the uptake of faecal immunohistochemical test among South Asian older adults: A cluster-randomised controlled trial

BackgroundColorectal cancer screening, including faecal immunohistochemical test, is an effective method for detecting colorectal cancer early. Nevertheless, faecal immunohistochemical test uptake among South Asian ethnic minorities is low because they have limited knowledge of and face barriers in accessing colorectal cancer screening. Tailored education and appropriate messaging has potential to convey to this population group the importance of colorectal cancer screening. ObjectivesThis study aimed to assess the acceptability and effectiveness of a family-based multimedia intervention to raise awareness of colorectal cancer screening and increase the uptake of faecal immunochemical tests among South Asian older adults. DesignA cluster-randomised controlled trial with a wait-list control group. ParticipantsThree-hundred and twenty dyads of South Asian older adults and their younger family members were recruited at South Asian community centres and non-governmental organisations providing support services to local South Asians in six Hong Kong districts. MethodsGroup allocation of dyads during cluster randomisation was based on the group assignment of the district where they were recruited. The intervention comprised a multimedia health talk, conveying the importance of colorectal cancer screening and support from younger family members in encouraging their older relatives to undergo screening. Site coordinators assisted participants in accessing faecal immunohistochemical test. The primary outcome was increased uptake of faecal immunohistochemical test among South Asian older adults. Secondary outcomes included younger family members' encouragement of their older relatives to undergo faecal immunohistochemical test and their readiness to assist their relatives with the test. Acceptability of the intervention was measured by dyad satisfaction with the intervention. ResultsThe proportion of older adults participating in faecal immunohistochemical testing was significantly higher among intervention dyads compared with controls (71.8% vs 6.8%, p < 0.001). No significant within-group change was observed on the willingness of younger family members in the intervention group to encourage older adults to undergo faecal immunohistochemical test, nor their readiness to assist older adults in doing so, although a decrease in both outcomes was observed among the control group. Most participants (>86%) were satisfied with the intervention. ConclusionsOur findings demonstrate the acceptability and effectiveness of the intervention in enhancing faecal immunohistochemical test uptake among South Asian older adults, and the benefit of using a family-based approach in the implementation of cancer screening interventions for these individuals. Implementation of the intervention as a component of usual care within South Asian communities is recommended.Trial registration ISRCTN72829325, 10 July 2018.

Determining frequency and reasons associated to refusal of colorectal cancer screening at a reference center in Mexico.

67 Background: in Mexico, Colorectal Cancer (CRC) is a leading cause of cancer death, yet population-based screening programs are lacking. In our center, a cohort was created to validate a risk calculator to detect advanced colorectal neoplasia, and to understand barriers to implement a CRC screening program. We aimed to determine frequency and reasons associated to rejection of CRC screening in our population. Methods: from August 2019 to March 2020 (early close owing to COVID-19 pandemic) asymptomatic individuals between 50 and 75 years-old with standard-risk for CRC, without previous screening for CRC, from the outpatient internal medicine clinic at a tertiary care center in Mexico City, received standardized information on the importance of CRC screening and were invited to perform both Fecal Immunochemical Test and a screening colonoscopy within a clinical study at no cost. Individuals who rejected participation were given a 10-item questionnaire to select reasons for refusal, as many items as applied. Here we present two groups: 1) individuals who refused to receive information and to perform screening studies, and 2) individuals who refused to participate after receiving information. Results: 162 patients were invited to participate, 77 (47%) refused: 48 rejected immediately (group 1) and provided 51 reasons, and 29 declined after having received standardized information about CRC screening (group 2) and provided 30 reasons. Demographics for 77 patients were: 54 (70.1%) women, median age 66 (IQR 58-71) years. Main reasons for rejection in both groups were: “I do not have time” in 24 (29.6%) times, “I am not interested” in 23 (28.4%) times, and “I am scared” in 14 (17.3%) times (Table). Conclusions: in our cohort, we identified that nearly half of the population invited to participate in a CRC screening program refused. Main reasons were lack of time, lack of interest and fear. This may translate poor understanding on the importance of measures to prevent CRC, and absence of education programs to recall its importance. In order to increment participation in CRC screening, education and awareness campaigns should be implemented.[Table: see text]

Association between metabolic syndrome and its components and incident colorectal cancer in a prospective cohort study.

Metabolic syndrome (MetS) has been identified as a contributor to cancer development. However, reports concerning the association between MetS and colorectal cancer (CRC) have been inconsistent. This study investigated whether MetS, its components, and the number of components increase the risk of CRC. This was a prospective cohort study of 41,837 participants recruited from August 2002 to December 2014 from the National Cancer Center in South Korea. The participants were followed until December 2017 to identify incident CRC cases. The participants underwent laboratory tests at the baseline. Additionally, a self-administered questionnaire collected information concerning lifestyle and general characteristics at the baseline. A Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to explore the association between MetS and its components and CRC risk after adjustments for confounding variables. In total, 128 incident CRC cases were identified during the follow-up period. An increased CRC risk was found among participants with MetS (HR, 1.63; 95% CI, 1.08-2.44). Additionally, elevated blood pressure (HR, 1.50; 95% CI, 1.05-2.15) and a high fasting glucose level (HR, 1.80; 95% CI, 1.23-2.63) were associated with an elevated risk of CRC. Notably, an increased risk was identified among participants with abdominal obesity coexisting with another component of MetS. These results suggest that MetS is a risk factor for CRC. Greater emphasis should be placed on the importance of CRC screening among individuals with abdominal obesity coexisting with another component of MetS. Colorectal cancer (CRC) ranks as the third most common cancer type in terms of incidence. Metabolic syndrome (MetS) has been identified as a contributor to cancer development. However, the association between MetS and CRC remains controversial because of a lack of consistent findings in previous studies. In this study, the National Cholesterol Education Program's Adult Treatment Panel III guidelines are used for the diagnosis of MetS. MetS is found to be a predictor of CRC. Additionally, the importance of CRC screening among individuals with 2 components of MetS should be emphasized.

S1987 Go With Your Gut Feeling: A Case of Invasive Colonic Squamous Cell Carcinoma Not Detected by DNA-Based Stool Testing

Introduction: Though less common, colonic squamous cell carcinoma is a type of colorectal cancer. Current colorectal cancer screening recommendations for average-risk patients include the use of stool DNA-based testing as an alternative to screening colonoscopy. This clinical vignette is an example of colonic squamous cell carcinoma that went undetected by a stool DNA-based colorectal cancer screening test. Case Description/Methods: 57 year-old female with no prior medical history presented to outpatient gastroenterology office for evaluation of tenesmus, mucus in stool with associated diarrhea and LLQ pain of 3 months duration. Physical exam was unremarkable. Recent CBC, BMP, and albumin were within normal limits. Patient had undergone average-risk colorectal cancer screening with a stool DNA-based test 11 months prior to presentation (8 months prior to symptom onset) with a negative result. Patient was asymptomatic at the time of the screening test. Due to her new symptoms, it was recommended she undergo infectious stool studies and colonoscopy. C difficile screen, bacterial stool culture and parasitology exam were negative. Colonoscopy revealed a 6-cm partially circumferential frond-like/villous, infiltrative and ulcerated partially obstructing large mass 4-11cm from the anal verge (Figure 1A, B). Biopsy was positive for invasive squamous cell carcinoma. The patient was referred to oncology and completed definitive chemo-radiation therapy with no evidence on residual disease on most recent imaging. Discussion: This case demonstrates an average-risk patient who underwent stool DNA-based testing for colorectal cancer screening that was negative with subsequent presentation and diagnosis of invasive squamous cell carcinoma of the colon in less than one year’s time. It highlights the importance of colorectal cancer screening and the ability of colonoscopy to detect and diagnosis colorectal cancer. DNA-based stool testing is an alternative non-invasive screening test to colonoscopy in average-risk patients. The current data supports a false negative rate of DNA-based stool testing to be less than 1 in 1500. However, the presence of a false negative test provides patients with a false sense of confidence and reassurance that they do not have cancer. It is imperative that for any new lower GI symptoms or other clinical suspicion for colorectal malignancy, the patient should still undergo evaluation with colonoscopy – endoscopic evaluation should not be deferred because of a recent negative DNA-based stool test.Figure 1.: A. Colon with mass, B. Detailed view of ulcerated mas.

Cross-sectional Study of Colorectal Cancer Screening Barriers in a Latino-Serving Federally Qualified Health Center.

Compared to other races/ethnicities, the Latino population has a lower rate of adherence to colorectal cancer (CRC) screening guidelines. Previous studies have identified a variety of barriers to CRC screening in Latino populations but have not explored factors associated with barriers. The purpose of this study was to identify barriers to CRC screening and associated factors in a Midwest Latino population visiting an urban Federally Qualified Health Center (FQHC). We conducted a cross-sectional investigation of 68 Latinos at a FQHC from June to October 2017. We examined factors associated with scheduling, psychological, and financial barriers using t-test, ANOVA, and multiple linear regression analyses. Our participants reported low educational level, low income, and limited access to insurance or a primary care provider. Scheduling barriers are the highest barrier compared with psychological and financial barriers. Being married or coupled was the only predictor of higher scheduling barriers (P < .05). Being married or coupled was associated with higher psychological barriers in both univariate and multivariate analysis (P < .05). Higher education level was associated with higher psychological barriers in univariate (P < .05) but not multivariate analysis. Participants with lower vs. higher English proficiency had a higher financial barrier score in univariate (P < .05) but not multivariate analysis. Despite interventions targeting CRC screening barriers, including the provision of free at-home testing, perceived barriers persist. Bilingual patient navigators may help address needs for those with limited English proficiency to find and schedule free or reduced-fee colonoscopy services. People who are well educated are also at high risk of psychological barriers and should be targeted and given more education on the importance of CRC screening.

Quality expectations in endoscopy – Hungarian guideline

Nowadays, endoscopy is the cornerstone in the diagnosis and therapy of gastrointestinal diseases. Good quality endoscopy can improve outcome of the disease and patients experience. International endoscopy societies prioritized efforts improving quality of endoscopy. The highest level of patient care can be provided through continuous assessment and improvement of relevant quality indicators. The comparison of these evidence based performance measures between endoscopists and endoscopy providers allow the objective evaluation of the service. Furthermore, from the point of view of patient safety and cost effectiveness the health care provider should know the minimum standards and target goals, as well, to make grounded decisions about fields of necessary changes and improvements. The authors based on European guidelines worked out this comprehensive auditable Hungarian system of performance measures in the fields of upper endoscopy, lower endoscopy, pancreatobiliary endoscopy, capsule endoscopy, enteroscopy and general endoscopy service. Due to commonality all domains were counted similarly (1–8) in different endoscopic procedures. The general endoscopy service is an exception with 9 domains and 30 quality parameters. The outstanding importance of colorectal cancer screening required involving this topic into this guideline with separate structure, as well as the basics of bowel preparation.

Assessment the Characteristic Features of Colorectal Cancer among Patients Attending Tikrit Teaching Hospital from 2009-2013

Background: Colorectal cancer is a frequent malignant gastrointestinal tumor. The studies in the "Iraqi Cancer Registry" from eighties revealed that the incidence of this cancer in Iraq duplicated up to (2.6%), but six to thirteen percent in the developed countries and higher in industrial countries about seventeen to fifty percent. It is the second cause of death in the western countries; colorectal cancer is ranked, after lung and prostate cancer in male, while it is after breast and lung cancer in females. The disease is frequent among elderly but (6-8%) of patients were 40 years and younger. Colorectal cancers are of favourable prognosis if early diagnosis and treatment provided. This study aims to assess the frequency of colorectal cancer in Tikrit city, to highlight the recently noted increase in frequency among young. Patients and Methods: The current study is cross-sectional study done in January 2014 when all recorded cases of colorectal cancer 2009-2013 involved in the study. It enrolled (172) patients with colorectal cancer chosen as a convenience sample. Data collected from hospital records (records between the 1st of January 2009 to the 31st of December 2013) in statistic unit in Tikrit Teaching Hospital. The demographic information, distribution, presentation, histopathological types and staging have been described. The staging system used in this study was the modified Dukes' staging system (6) . Results: Of the (172) patients involved in this study, 94 patients (54.7%) were males and 78(45.3%) were females with a male: female ratio of (1.2:1), mean age was (51.4) years and peak age of occurrence was (60-69) years age group. The main presenting symptom was abdominal pain (42.4%). The most common site of the tumor was the rectum (35%) and (97.8%) of cancers were adenocarcinomas of which (66.7%) were moderately differentiated. (38%) of cases were at Duke‘s stage B when diagnosed. Conclusion: The study showed an increase colon cancer frequency during the year 2013 compared with previous years, with a notable increase among young adults, high percentage of them presented with advanced and aggressive disease. Recommendations: Increase awareness of population about the importance of colorectal cancer screening to discover a disease at early stage which can be treated completely.

Colorectal cancer knowledge and perceptions among individuals below the age of 50.

Colorectal cancer (CRC) rates are increasing in individuals below the age of 50 and this trend has been projected to continue for the foreseeable future. Health officials are calling for increased awareness of rising rates in affected populations to promote discussion and early detection. In May 2018, we surveyed an online purposive sample of adults below the age of 50 (N=624). We conducted an exploratory analysis examining knowledge of current CRC screening guidelines, knowledge of available CRC screening methods, perceived risk of CRC, and perceived importance of screening for CRC by gender, race, and previous CRC screening activity. The sample was 56% female, averaged 36years of age, largely identified as Caucasian (84%), married (48%), and well educated (70% with some college or a college degree). 36% correctly identified the current age of recommended CRC screening initiation. Few (8%) correctly identified all CRC screening options presented. Genetics was thought to be the most relevant determinant of CRC. African American or black participants perceived themselves to be at lower risk of CRC, while women rated the importance of screening significantly lower thanmen. We identified a lack of CRC knowledge in individuals below the age of 50. Interventions should correct perceptions of risk of CRC and highlight the importance of screening. Complete knowledge of the range of screening options may reduce barriers to screening while a greater knowledge of modifiable risk factors of CRC can promote healthy behaviors.

Abstract 59: Examining a Culturally Relevant Intervention to Promote Colorectal Cancer Screening in Egypt

Abstract Purpose: Colorectal cancer (CRC) incidence and mortality rates continue to climb in Egypt and other low- and middle-income countries, where few screening intervention programs exist. In Egypt, CRC screening is not a routine part of preventive care and most CRC diagnoses happen with advanced disease and poor prognosis. This pilot study aims to develop, implement, and examine the feasibility of a culturally relevant intervention to promote CRC screening among healthy adults in Alexandria, Egypt. Methods: This feasibility study was conducted in two clinics in Alexandria, Egypt in December 2019-March 2020. Participants were individuals age 50 and above who were visiting the clinics. Medical students were trained to recruit patients, increase awareness on the importance of CRC screening, and provide a voucher and instructions for returning a guaiac fecal occult blood test (gFOBT) kit. Students followed up with phone call reminders to return the kit, report results, and encourage participants with abnormal results to receive further no-cost testing. Our outcome measure was the number of total participants returning the gFOBT kit. We hypothesized that 20% of patients who received the intervention would return the kits, assuming a null screening rate of 2% and target screening rate after the intervention of 20%. A sample size of 120 would achieve 99% power to detect a difference of 18% at a 1% significance level. Results: Of the 117 patients who were recruited, 44 patients (37.6%) returned a kit, with 95% exact confidence interval of (28.8, 47.0). Of the 44 patients who returned a kit, five (11.4%) had a positive FOBT test, with 95% exact confidence interval of (3.8, 24.6). Of these five patients, three (60%) followed up with colonoscopy. Conclusion: This feasibility study provides promising findings to lay the foundation for a larger pragmatic trial that would address barriers to CRC screening in Egypt Citation Format: Lori Brand Bateman, Ahmed Nawwar, Somaia Khamess, Mona N. Fouad, Waleed Arafat, Salah-Eldin Abdelmoneim, Sejong Bae, Katie Falkner, Laura Q. Rogers, Isabel Scarinci. Examining a Culturally Relevant Intervention to Promote Colorectal Cancer Screening in Egypt [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 59.

Barriers of colorectal cancer screening test among adults in the Saudi Population: A Cross-Sectional study.

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer death worldwide. CRC can be completely cured if detected at an early stage with screening. However, many barriers to screening have been reported. This study aimed to identify the potential barriers to CRC screening among the Saudi population aged ≥45years. A cross-sectional study of randomly selected adults (aged ≥45years) attending primary care clinics at KKUH in Saudi Arabia was conducted. A self-administered questionnaire was used to collect data. A total of 448 participants were included. In general, the most commonly reported barrier to CRC screening was a lack of physician recommendation (77.1%). Moreover, fear of painful colonoscopy procedures and a lack of knowledge regarding the availability of the fecal occult blood test (FOBT) were reported by 51.6% and 57.8% of patients, respectively. Significant gender differences were observed, with females reporting more barriers to CRC screening than males (general barriers [p<0.001] and colonoscopy-specific barriers [p=0.003]). Participants who had not undergone any previous CRC screening reported significantly more barriers compared to those who had undergone a previous CRC screening (general barriers [p=0.015], colonoscopy-specific barriers [p=0.006], and FOBT specific barriers [p=0.024]). Because a lack of physician recommendation was the most commonly reported general barrier, we recommend that physicians emphasize the need for CRC screening, particularly to high-risk patients. Extensive campaigns and programs must be launched to raise awareness about the importance of screening for CRC. Additionally, gender-specific strategies need to be formulated to promote CRC screening in females.

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.

Abstract C129: Do phone-based discussions about the importance of colorectal cancer screening delivered before a fecal immunochemical test (FIT) mailing improve return rates?

Abstract Patients who have never completed a fecal immunochemical test (FIT) may benefit from phone-based discussions about the importance of colon cancer screening before receiving the FIT in the mail. Colorectal cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinxs. In 2015, only 63% of eligible adults, and 50% of Latinxs, were up to date with colorectal cancer screening recommendations. Mailed FIT outreach programs have been shown to improve colorectal cancer screening rates in community health centers, with improvements ranging from 22% – 45%. Despite the widespread use of primers and reminders for mailed FIT outreach programs, data are sparse on how these communications influence FIT completion rates. Data from our previous evaluation of mailed FIT outreach showed that adults who have never completed a FIT have a much lower FIT return rate than adults who have (17.1 vs 45.1; p &amp;lt; 0.01). As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT), which involved a partnership with a Los Angeles-based community health center that provides medical services to 300,000 patients annually (82% are Latinx), we tested whether patients who had never completed a FIT could benefit from phone-based discussions about the importance of colorectal cancer screening. Eligible patients were 50-74, due for their screening, and assigned to a wedge 1 clinic (n = 8 clinics; 6,872 patients). A total of 2,825 patients had no electronic health record evidence of having completed a prior FIT. These patients were randomized to receive the text primer (n = 1,622) or live call primer (n = 1,203). All live primer calls were delivered by bilingual health education staff trained by the research team. Patients were then mailed a FIT kit with an introductory letter and wordless instructions on completing the FIT, followed by two automated phone call reminders and live reminder calls delivered by the care team. We used logistic regression to compare the effectiveness of live call vs text message primers on FIT completion rates 3 months after the FIT mailing. Randomized patients (who had never completed the FIT) had a mean age of 58 years (SD, 6.0), 51% were female, and 80% Latinx. In the text primer arm, the overall FIT completion rate was 14.7%, and 14.6% among those who were successfully delivered the text primer. In the live call arm, the overall FIT completion rate was 18.8%, and 30.0% among those who had a discussion with health education staff. Controlling for age, preliminary analyses indicate that patients who received a live call were 1.35 times more likely to complete a FIT within 3 months of the mailing than those who received a text message primer (OR=1.35 [1.10, 1.64]). Live phone call primers, delivered before the FIT is mailed, boost screening rates among those who have never completed a FIT. Note: This abstract was not presented at the conference. Citation Format: Jamie Thompson, Denis Nyongesa, Amanda Petrik, Melissa Castillo, Gloria Coronado. Do phone-based discussions about the importance of colorectal cancer screening delivered before a fecal immunochemical test (FIT) mailing improve return rates? [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 C129.

3075 Initial Presentation of Advanced Colorectal Cancer in the Cecum Presenting With Mild Tenesmus

INTRODUCTION: Colorectal cancer (CRC) is a lethal disease. 140,250 new cases of large bowel cancer are diagnosed annually in the USA including 97,220 colon and 43,030 rectal cancers. 50,630 Americans are expected to die of large bowel cancer each year. CRC is the third most common cause of cancer death in the USA in women, and the second leading cause of death in men. Common symptomology include change in bowel habits (74%), rectal bleeding with change in bowel habits (71%), iron deficiency anemia (21%). Appendicitis as the initial symptom of CRC is less than 1% for individuals over 40. CASE DESCRIPTION/METHODS: Patient is a 52 year old man who presents to our facility for general abdominal pain and tenesmus for three months. The patient has no family history of CRC nor colonoscopy. In the ED routine labs negative Imaging revealed acute appendicitis. Laparoscopic appendectomy was performed and the patient was discharged the following day. Patient returned two months later with complaints of tenesmus and abdominal pain. In the ED acute microcytic anemia was discovered. CT Abdomen and pelvis demonstrated diverticulosis without diverticulitis and FOBT positive. Colonoscopy performed and findings consisted of: large 6 cm cecal mass, biopsies taken, 8 mm polyp in transverse colon removed with cold snare, two 5-7 mm polyps in the ascending colon removed by cold snare, and 4 cm polyp removed via the hot snare in the descending colon. The patient then underwent colonic resection of the mass by general surgery. DISCUSSION: What is learned from this case is the importance of CRC screening and rare initial symptom of CRC of appendicitis in a male over the age of 40. The patient is 52 years old with without having CRC screening and acute appendicitis. Had the patient had his diagnostic colonoscopy at the age of 50 the cecal mass would have been discovered sooner and treatment could have been initiated. Another aspect of this case that makes it unusual was the patient did not have any of the more common symptoms of CRC. Our patient presented with general abdominal pain and tenesmus and the latter accounts for less than 1% of all symptomatology along with acute appendicitis. The patient did not have any of the “alarm” symptoms and if not for the appendicitis diagnosed in the hospital the patient “had no intentions” of doing CRC screening. The patient explains he had no family history of gastric or colon cancers, “So why bother?” The acute appendicitis from the cecal mass proved to be critical in the initiation of treatment.

Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities

IMPORTANCEColorectal cancer screening rates are suboptimal, particularly among sociodemographically disadvantaged groups.OBJECTIVETo examine whether guaranteed money or probabilistic lottery financial incentives conditional on completion of colorectal cancer screening increase screening uptake, particularly among groups with lower screening rates.DESIGN, SETTING, AND PARTICIPANTSThis parallel, 3-arm randomized clinical trial was conducted from March 13, 2017, through April 12, 2018, at 21 medical centers in an integrated health care system in western Washington. A total of 838 age-eligible patients overdue for colorectal cancer screening who completed a questionnaire that confirmed eligibility and included sociodemographic and psychosocial questions were enrolled.INTERVENTIONSInterventions were (1) mail only (n = 284; up to 3 mailings that included information on the importance of colorectal cancer screening and screening test choices, a fecal immunochemical test [FIT], and a reminder letter if necessary), (2) mail and monetary (n = 270; mailings plus guaranteed $10 on screening completion), or (3) mail and lottery (n = 284; mailings plus a 1 in 10 chance of receiving $50 on screening completion).MAIN OUTCOMES AND MEASURESThe primary outcome was completion of any colorectal cancer screening within 6 months of randomization. Secondary outcomes were FIT or colonoscopy completion within 6 months of randomization. Intervention effects were compared across sociodemographic subgroups and self-reported psychosocial measures.RESULTSA total of 838 participants (mean [SD] age, 59.7 [7.2] years; 546 [65.2%] female; 433 [52.2%] white race and 101 [12.1%] Hispanic ethnicity) were included in the study. Completion of any colorectal screening was not significantly higher for the mail and monetary group (207 of 270 [76.7%]) or the mail and lottery group (212 of 284 [74.6%]) than for the mail only group (203 of 284 [71.5%]) (P = .11). For FIT completion, interventions had a statistically significant effect (P = .04), with a net increase of 7.7% (95% CI, 0.3%–15.1%) in the mail and monetary group and 7.1% (95% CI, −0.2% to 14.3%) in the mail and lottery group compared with the mail only group. For patients with Medicaid insurance, the net increase compared with mail only in FIT completion for the mail and monetary or the mail and lottery group was 37.7% (95% CI, 11.0%–64.3%) (34.2% for the mail and monetary group and 40.4% for the mail and lottery group) compared with a net increase of only 5.6% (95% CI, −0.9% to 12.2%) among those not Medicaid insured (test for interaction P = .03).CONCLUSIONS AND RELEVANCEFinancial incentives increased FIT uptake but not overall colorectal cancer screening. Financial incentives may decrease screening disparities among some sociodemographically disadvantaged groups.TRIAL REGISTRATIONClinicalTrials.gov identifier:

Abstract 4195: Clinical, endoscopic and histological aspects of colorectal cancer at the CHU de Cocody

Abstract Introduction: The colorectal cancer (CRC) is the 4th cancer in Côte d’Ivoire (WHO 2014). Its overall prevalence appears to be advancing in sub-Saharan Africa over the years. The CRC frequently occurs at an early age and is very often discovered at an advanced or even late stage, with a bad prognosis. Aims: To assess the clinical, endoscopic and histological aspects of CRC. Patients and methods: An observational retrospective study was conducted from the reports of lower GI (LGI) endoscopies performed at the GI Endoscopy Unit between 2008 and 2018. The diagnosis of CRC was retained on the basis of the macroscopic and/or the histological aspect of the tumor. The following parameters were collected : number and indication of LGI endoscopies, age, gender, macroscopic appearance, location and histological type of the tumor. Results: Over the study period, 2118 LGI endoscopies were carried out. We found 145 CRCs, corresponding to an endoscopic prevalence of 7%. The annual prevalence was 18,13 cases. A CRC was diagnosed every 14,6 LGI endoscopies performed. The sex ratio was 1,42. Median age was 56 years, with extremes of 14 and 92 years. Patients younger than 40 years (with a median age of 32 years) accounted for 18% of cases. Rectorrhagia was the main cause of LGI endoscopies found in 48 patients (33,1%), followed by an imaging discovery (ultrasound and/or abdominal CT scan) of a colorectal tumor in 38 patients (27,2%), abdominal pain or constipation in 15,3% of cases (21 patients), weight loss in 13 patients (9,5%), abdominal or anorectal mass in 8% of cases (11 patients), chronic diarrhea in 8% of cases (11 patients), metastatic tumor liver in 9 patients (6,6%), melaena in 4,4% of cases (6 patients) and anemia in 3 patients (2,2%). Macroscopically, rectal localization was the most common with 42,36% of cases, followed by sigmoid (36,1%), cecum (16,7%), right colon (11,8%), colon transverse (7%) and left colonic angle (2,8%). The ulcerative-budding form was the most common (88,65%), with strictures in 57,5% of cases and necrotic-hemorrhagic in 48,23% of cases; followed by the polypoid form (4,25%). There were no ulcerative and infiltrative form. The histological type was found in 30 patients (4,83%). Adenocarcinoma was the most common (93,3%). Stromal tumor was found in 3,3% of the cases. Conclusion: This work confirms that the prevalence of CRC has increased in Côte d’Ivoire, that it occurs at an early age and that it is discovered at an advanced stage. This work highlights the importance of screening for CRC as early as possible in front of a Rectorrhagia, even in young patients. Citation Format: Serge Franck Roland Fonkoua Fohom. Clinical, endoscopic and histological aspects of colorectal cancer at the CHU de Cocody [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4195.