Increase Colorectal Cancer Screening Research Articles

Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial

BackgroundApproximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC...

Developing a Social Marketing–Based Colorectal Cancer Screening Campaign Centered on Stool-Based Testing for Patients Utilizing Services at a Federally Qualified Healthcare Center

Background More than 50% of colorectal cancer (CRC)–related deaths could be prevented with early detection and treatment. Federally Qualified Healthcare Centers (FQHCs)—safety-net facilities that provide primary care services to uninsured, underinsured and minority patients—report some of the lowest CRC screening rates. Effective CRC screening interventions within FQHCs may help to promote CRC screening utilization among patients from diverse backgrounds. Focus of Article This study was designed to explore average-risk, patient perceptions of facilitators and impediments of using the Fecal Immunochemical Test (FIT) kit for CRC screening within the social marketing framework of the 4 “P’s”—product, price, place, and promotion. Research Aim To conduct formative research with priority populations (i.e., diverse, FQHC patients), assess acceptability of the FIT kit, and identify ways to better meet preferences and needs. Program Design/Approach Qualitative, Focus Groups. Importance to the Social Marketing Field Findings from this study would aid in the future development of a community-based prevention marketing intervention to promote CRC screening within FQHCs that serve diverse patient populations. Methods Focus groups were conducted in English and Spanish with CRC screening age-eligible patients from a South Florida FQHC System. Interview guides were designed to better understand FQHC patient perceptions of CRC Screening via the FIT kit (product) by up-to-date and not up-to-date participants. Additional topics included likes/dislikes (price), preferred location for completing CRC screening and receiving CRC prevention education (place), and strategies for persuasive communication to increase CRC screening among patients who visit FQHCs (promotion). Data were analyzed to identify FIT screening facilitators and impediments using thematic coding in MaxQDA. Results Five focus groups, involving 36 participants aged 50 and older, were conducted. Over half of participants self-identified as Hispanic (36%) or non-Hispanic Black (28%). Key facilitators were the convenience and simplicity of at-home testing (product), presumed affordability of it compared to colonoscopy (price), and ability to return by mail (place). Participants also shared numerous strategies for promotion, including direct referral from Primary Care Providers, mass media campaigns, mailed or electronic reminders from the clinic, and peer advocacy events in churches. Recommendations for Research or Practice Social marketing provides an adequate approach for developing a patient-centered campaign to promote CRC screening uptake at FQHCs. Future CRC screening promotional campaigns at FQHCs should build on the motivation that patients must prioritize their health by emphasizing the convenience of completing CRC screening at home with the capability of mailing it back. Clinics should also work to reduce patient responsibility by developing automated clinic system reminders to openly communicate with patients about CRC screening.

Barriers and Facilitators of Colonoscopy Screening Among Latino Men in a Colorectal Cancer Screening Promotion Program.

Colorectal cancer (CRC) is the second leading cause of cancer death among Latino men in the United States, yet they have low screening rates. This study explored barriers and facilitators of colonoscopy screening among Latino participants in a CRC screening promotion program. Six focus groups were conducted, in Spanish, with 45 Latino men, of which 28 had received and 17 had not received a colonoscopy. Analysis of the discussion transcripts identified barriers to CRC screening, facilitators to CRC screening, and recommendations for health information dissemination. There was consensus among all participants that they had not received adequate information on colonoscopy screening from their health care providers. Unscreened participants wanted more details about the colonoscopy procedure and bowel preparation. Screened men were more knowledgeable than unscreened men about CRC, the colonoscopy procedure, and the benefits of early detection. Participants also expressed their fears, concerns, and perceptions of stigma in relation to colonoscopy screening. They described family and personal testimonials as facilitators to engaging in colorectal cancer screening. Findings underscore the need for ongoing research and educational efforts to address personal and cultural stigma surrounding colonoscopy and CRC, particularly in underserved communities. Study findings also highlight the danger of missing out on opportunities to increase CRC screening when colonoscopy is the primary screening option offered. Additional research is needed to ensure trust in the health care system and to examine the effectiveness of testimonials on CRC screening among Latino men.

Colorectal cancer screening completion by patients due or overdue for screening after reminders: a retrospective study

BackgroundPatient and clinician reminders were implemented as part of an adherence improvement project at University of Florida (UF) Internal Medicine Clinics. We sought to assess colorectal cancer (CRC) screening completion rates among patients not up-to-date with screening following distribution of reminders and to identify characteristics correlated with screening outcomes.MethodsRetrospective chart review was performed for patients not up-to-date with CRC screening for whom at least one reminder (patient and/or clinician) was issued in June 2018. The primary endpoint, the completion of a CRC screening test, is characterized as the ratio of completed screening tests to the number of patients not up-to-date with screening. All analyses were performed using R 4.0 software.ResultsOf the 926 patients included, 403 (44%; 95% CI, 0.40–0.47) completed a CRC screening test within 24 months following a reminder. Family history of CRC (relative risk (RR) 1.33; P = 0.007), flu immunization within two years of the reminder (RR 1.23; P = 0.019), and receiving a patient reminder either alone (RR 1.62; P < 0.001) or in combination with a clinician reminder (RR 1.55; P = 0.006) were positively associated with CRC screening completion. Reporting being divorced, separated, or widowed was negatively associated with screening completion (RR 0.70; P = 0.004).ConclusionReminders, in particular patient reminders, seem to be an effective method to enhance screening among patients not up-to-date with CRC screening. This study suggests that reminder efforts should be focused at the level of the patients and provides insight on target populations for practical interventions to further increase CRC screening adherence.

Effectiveness and implementation of mPATH™-CRC: a mobile health system for colorectal cancer screening

BackgroundScreening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates.MethodsThe mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC). In this study, the mPATH™ program is evaluated through a Type III hybrid implementation-effectiveness design. Specifically, the study consists of three parts: (1) a cluster-randomized controlled trial of primary care clinics comparing a “high touch” evidence-based implementation strategy with a “low touch” implementation strategy; (2) a nested pragmatic study evaluating the effectiveness of mPATH-CRC™ on completion of CRC screening; and (3) a mixed-methods study evaluating factors that facilitate or impede the maintenance of interventions like mPATH-CRC™. The primary objective is to compare the proportion of patients aged 50–74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation between the “high touch” and “low touch” implementation strategies. Effectiveness of mPATH™-CRC is evaluated by comparing the proportion who complete CRC screening within 16 weeks of their visit to the clinic between a pre-implementation cohort (8 months before implementation) and a post-implementation cohort (8 months after implementation).DiscussionThis study will provide data on both the implementation of the mPATH™ program and its effectiveness in improving screening rates for CRC. In addition, this work has the potential to have an even broader impact by identifying strategies to support the sustained use of other similar technology-based primary care interventions.Trial registrationClinicalTrials.gov NCT03843957. Registered on 18 February 2019.

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement

Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics’ adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation.

Colorectal cancer (CRC) is currently the second leading cause of cancer-related deaths in the United States; however, it is mostly preventable with appropriate screening and is often treatable when detected at early stages. Many patients enrolled in an urban Federally Qualified Health Center (FQHC) clinic were found to be past due for CRC screening. This study described a quality improvement (QI) project to improve CRC screening rates. This project used bidirectional texting with fotonovela comics and natural language understanding (NLU) to encourage patients to mail fecal immunochemical test (FIT) kits back to the FQHC. The FQHC mailed FIT kits to 11,000 unscreened patients in July 2021. Consistent with the usual care, all patients received 2 text messages and a patient navigator call within the first month of mailing. As part of a QI project, 5241 patients who did not return their FIT kit within 3 months, aged 50-75 years, and spoke either English or Spanish were randomized to either usual care (no further intervention) or intervention (4-week texting campaign with a fotonovela comic and remailing kits if requested) groups. The fotonovela was developed to address known barriers to CRC screening. The texting campaign used NLU to respond to patients' texts. A mixed methods evaluation used data from SMS text messages and electronic medical records to understand the impact of the QI project on CRC screening rates. Open-ended text messages were analyzed for themes, and interviews were completed with a convenience sample of patients to understand barriers to screening and impact of the fotonovela. Of the 2597 participants, 1026 (39.5%) in the intervention group engaged with bidirectional texting. Participating in bidirectional texting was related to language preference (χ22=11.0; P=.004) and age group (χ22=19.0; P<.001). Of the 1026 participants who engaged bidirectionally, 318 (31%) clicked on the fotonovela. Furthermore, 54% (32/59) of the patients clicked on the fotonovela and responded that they loved it, and 36% (21/59) of patients responded that they liked it. The intervention group was more likely to get screened (487/2597, 18.75%) than those in usual care (308/2644, 11.65%; P<.001), and this pattern held, regardless of demographic subgroup (sex, age, screening history, preferred language, and payer type). Interview data (n=16) indicated that the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Interviewees noted several important barriers to CRC screening and offered suggestions for reducing barriers and increasing screening. Texting using NLU and fotonovela is valuable in increasing CRC screening as observed by the FIT return rate for patients in the intervention group. There were patterns in which patients did not engage bidirectionally; future work should investigate how to ensure that populations are not left out of screening campaigns.

European Cancer Summit 2022 Submission for Prevention, Early Detection and Screening NetworkEarly detection and screening of Colorectal Cancer (CRC) in Georgia

BackgroundAccording to GLOBOCAN 2020, CRC is the second cause of female cancer deaths (after breast cancer) and the fourth for men (after lung, prostate and stomach cancer) in Georgia, while both incidence and mortality have increased over the past decade. The aim of this study was to demonstrate the early detection and screening practice in patients with CRC among Georgian population. MethodsData was obtained from the national population-based cancer registry (PBCR) of Georgia. 795 incidence cases were analysed for all sites of the colon, rectum and anus combined (C18–C21) during 2021. ResultsAge of the study participants ranged from 26 to 93 years old, median age was 67 years (IQR: 59 – 74) for men and 66 years (IQR: 59 – 73) for women, 51.70% of cases were between the age group 50-70. One-fifth of all new CRC cases are diagnosed at a distant stage and 19.24% of patients with newly diagnosed disease die in the first year after diagnosing in country of Georgia. While screening for CRC is included in the national programme of cancer prevention (target population aged 50-70 years), only 5.40% of CRC cases were identified by screening and 22.89% of cases were diagnosed at the localized stage (I and II stage). ConclusionsDespite Georgian CRC screening program is an integrated part of the national healthcare system, secondary prevention and early detection practice in Georgia is very low. Acceleration of screening policy in the country is necessary. Educational and policy initiatives should be implemented to increase CRC screening, specifically focused on rural citizens who have lack access to healthcare infrastructure.

Colorectal Cancer Screening Among Adults in Zuni Pueblo: Factors Associated with FOBT and Colonoscopy Utilization.

Although strategies to mitigate barriers to colorectal cancer (CRC) screening have proven successful in some parts of the US, few of these strategies have been studied in rural, American Indian communities that may exhibit unique culturally driven attitudes toward and knowledge of colorectal cancer and experience increased barriers to healthcare access. In this study, we describe the results of a survey among CRC screen-eligible members of Zuni Pueblo (N = 218) on an array of questions regarding CRC screening behaviors, knowledge, satisfaction with and access to healthcare services, social support for CRC screening, perceptions toward FOBT, and preference for evidence-based interventions or strategies for improving CRC screening rates. Results from the multivariable model suggest age, having a regular healthcare provider, and harboring fewer negative perceptions toward FOBT are key drivers of ever completing CRC screening. Respondents reported strong support for Community Guide-recommended interventions and strategies for increasing CRC screening for nearly all proposed interventions. Results confirm the need for multilevel, multicomponent interventions, with a particular focus on improving Zuni Pueblo community members' access to a regular source of care, improving knowledge of CRC risk factor, and addressing negative perceptions toward CRC screening. These results provide critical, community-specific insight into better understanding the drivers of low guideline-adherent screening rates and inform local healthcare providers and community leaders of context-specific strategies to improve CRC screening in Zuni Pueblo.

Abstract A104: Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT)

Abstract PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHODS: We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator; and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test; 2) completed test. Results by intervention will be assessed at 12 months. RESULTS: Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients “engaged” with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening. Citation Format: Beth A. Jones, Sakinah C. Suttiratana, Sarah A. DeGiovanni, Steven J. Parra, Levita Robinson, Michael Couturie, Louie Mar Gangcuangco, Denise Stevens. Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT) [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 A104.

Abstract A105: Participants with lower socioeconomic status or lacking access to health care benefited more from a decision support navigation trial to increase colorectal cancer screening: Study of Chinese and Korean American primary care patients

Abstract Background: Although colorectal cancer (CRC) is the second most common cancer among Asian Americans, cancer screening rates among Chinese- and Korean Americans are lower than in other racial/ethnic groups in the United States. To address this disparity, we designed, implemented, and evaluated the effectiveness of a culturally adapted decision support navigation trial. Methods: Twenty-four Chinese and Korean primary care physicians (PCPs) from Maryland and northern Virginia were recruited to the STOP CRC (Screening TO Prevent CRC) program, a cluster randomized controlled trial. The PCPs’ clinics were randomized into intervention or control group. Then, 400 Chinese and Korean Americans were recruited through the PCPs’ clinics. Participants randomized to a decision support navigation intervention group (n=200) received an informational booklet, instructions to access colonoscopy screening, and a free fecal immunochemical test (FIT) kit at baseline. A bilingual patient navigator also guided them through an exercise to facilitate screening test choices. Six months after enrollment, participants randomized to the control group (n=200) received the informational booklet, colonoscopy instructions, and a FIT kit. Participants were offered a choice to select between the FIT or colonoscopy. Screening (completion of FIT or colonoscopy) was measured at 6 and 12 months after enrollment by medical record review and self-report. Generalized estimating equations (GEE) models with an exchangeable working correlation matrix to account for clustering effects at the PCP level were employed to examine intervention effects on CRC screening outcomes. Results: Intervention and control participants were comparable in their socio-demographic background and access to healthcare at baseline. At 12 months, screening adherence in the intervention group was (93%) substantially higher than in the control group (63%) (Prevalence Ratio: 1.51, 95% confidence interval: 1.37-1.66). Interestingly, the effect of the intervention on CRC screening was significantly higher among those with less than or equal to high school education (PR=1.95; 95% CI: 1.89-2.02) compared to those with higher than high school education (PR=1.37; 95% CI: 1.37; 95% CI: 1.22-1.54). Moreover, the impact of the intervention on CRC screening was higher among participants with lower income (&amp;lt;$100,000: PR=1.60; 95% CI: 1.56-1.65) than the participants with higher income (≥$100,000: PR=1.18; 96% CI: 0.85-1.64). The same impact was higher among those without health insurance (PR=1.70; 95% CI: 1.28-2.25) and those with Medicare/Medicaid (PR=1.80, 95% CI: 1.29-2.52) compared to those who have private health insurance (PR=1.35, 95% CI: 1.19-1.53). Conclusions: The STOP CRC program, a culturally and linguistically adapted decision support navigation intervention, is effective in increasing CRC screening among Chinese and Korean American primary care patients who are not up-to-date with the screening. This impact is more pronounced among participants with lower socioeconomic status or lacking access to health care. Citation Format: Sunmin Lee, Soomin Ryu, Carissa Kwan, Ronald E. Myers, Yuxi Shi, Luohua Jiang, Brittany N. Morey. Participants with lower socioeconomic status or lacking access to health care benefited more from a decision support navigation trial to increase colorectal cancer screening: Study of Chinese and Korean American primary care patients [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 A105.

Distance and Transportation Barriers to Colorectal Cancer Screening in a Rural Community.

Rural residents in underserved areas face many barriers to health services, including colonoscopies for colorectal cancer (CRC) screening, but rural healthcare providers may assist patients navigating these challenges due to familiarity with local contexts. In 2017 to 2018, we interviewed clinical practitioners and staff (n = 40) at 13 primary care and gastroenterology locations across rural Southern Illinois. We used a semi-structured interview guide that addressed system, provider, and patient levels including domains related to barriers, facilitators, and needs for intervention. This article focuses on 3 main elements related to distance and transportation that emerged from inductive coding. First, providers described long distance travel for care as normalized but not necessarily preferable. Second, they identified and described distance-related challenges specific to CRC screening, and third, providers discussed strategies, mostly related to transportation, they use to navigate those challenges. Finally, they suggested a variety of broader solutions to reduce distance and transportation barriers to screening. Overall, distance to care remains a challenge to increasing CRC screening and contributes to disparities in rural communities. To increase early detection and reduce rural cancer disparities, efforts to increase screening and follow-up must address ways to help patients and providers navigate this distance within their local communities and contexts.

Exploration of Malaysian Stakeholders View on Barriers to and Facilitators of Colorectal Cancer Screening Among Older Population

According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (CRC) cases in Malaysia are presented in the advanced stages of the disease, leading to poor survival rates while taxing the health care system. This study aims to explore the barriers to and facilitators of CRC screening uptake in the perspectives of the general population, health care providers, and policymakers. In-depth, semi-structured interviews were conducted with 25 purposively sampled respondents comprising general population above the age of 40, health care providers, and policymakers. Commonly reported barriers to CRC screening included psychological, poor knowledge and awareness, lack of physicians' recommendation, and inadequate implementation of CRC-related campaigns at systemic level. Facilitating factors for CRC screening included family support and family history of CRC. A comprehensive understanding of barriers and facilitators is relevant for designing an effective intervention and policy to increase CRC screening rates in Malaysia.

Implementing a mailed stool sample screening program in clinics providing care for an underserved Hispanic population

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in Hispanics in the US. Despite this, Hispanics are being screened for CRC at a much lower rate than their non-Hispanic white counterparts. Implementing mailed fecal immunochemical tests (FITs) is a cost-effective intervention for increasing CRC screening rates in vulnerable populations, such as Hispanic populations in border metroplexes. We aimed to describe the effect of introductory calls coupled with mailed in-home FIT kits on CRC screening completion in two federally qualified health centers (FQHCs) in a US–Mexico border county. This was a prospective, pragmatic, two-arm intervention study with participants allocated to receive a FIT kit with a reminder call (usual care) or usual care preceded by an introductory call. The primary outcome was the percentage of patients who returned the FIT kits. Participants who returned to the FIT were primarily unemployed (54.4%), had less than a high school education (60.2%), lived in the US for at least 20 years (74.4%), and had poor self-reported health (54.4%). In addition, we observed a statistically significant increase in the absolute rate (4.5%, P = 0.003) of FITs returned when a mailed FIT kit was preceded by an introductory call compared with no initial call. This study demonstrated that adding an introductory phone call significantly improved the screening completion rate in a mailed-out CRC screening intervention in the US–Mexico border population.

Nudging to Increase Colorectal Cancer Screening Rates: A Cost-Benefit Analysis of a Medicare Mailed Fecal Immunochemical Test Program

This paper presents a cost-benefit analysis of the implementation of a mailed fecal immunochemical test (FIT) program for Medicare beneficiaries who have fallen behind on recommended colorectal cancer (CRC) screening. An ex-ante cost-benefit analysis was conducted to determine the total net benefits to US society of the implementation of a Medicare Mailed FIT program on one-year and 10-year timelines. Costs and benefits associated with the implementation of such a program were valued using Centers for Medicare and Medicaid Services (CMS) reimbursement rates and results from existing research. Analysis procedures followed Health and Human Services Guidelines for Regulatory Impact Analysis to the maximum extent possible. The base-case net benefits after program year one were estimated to be $9.6 billion with estimated 10-year net benefits of $74.5 billion. Best-case sensitivity analysis outcomes were estimated to be $22.7 billion in net benefits at the end of year one and $202.3 billion in net benefits on a 10-year timeline, while worst-case sensitivity analysis outcomes were estimated to be $1.4 billion in net benefits at the end of year one and $12.5 billion in net benefits on a 10-year timeline. Further sensitivity analyses all yielded positive net benefits on one and 10-year timelines indicating that the implementation of a mailed FIT program for Medicare beneficiaries who have fallen behind on CRC screening offers considerable net benefit to US society.

Small-Area Geographic and Socioeconomic Inequalities in Colorectal Cancer in Cyprus.

Colorectal cancer (CRC) is one of the leading causes of death and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The objective of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socioeconomic inequalities in Cyprus for the time period of 2000-2015. This is a small-area ecological study in Cyprus, with census tracts as units of spatial analysis. The incidence date, sex, age, postcode, primary site, death date in case of death, or last contact date of all alive CRC cases from 2000-2015 were obtained from the Cyprus Ministry of Health's Health Monitoring Unit. Indirect standardisation was used to calculate the sex and age Standardise Incidence Ratios (SIRs) and Standardised Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs, and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. To evaluate the association of CRC incidence and mortality rate with socioeconomic deprivation, we included the national socioeconomic deprivation index as a covariate variable entering in the model either as a continuous variable or as a categorical variable representing quartiles of areas with increasing levels of socioeconomic deprivation. The results showed that there are geographical areas having 15% higher SIR and SMR, with most of those areas located on the east coast of the island. We found higher M/I ratio values in the rural, remote, and less dense areas of the island, while lower rates were observed in the metropolitan areas. We also discovered an inverted U-shape pattern in CRC incidence and mortality with higher rates in the areas classified in the second quartile (Q2-areas) of the socioeconomic deprivation index and lower rates in rural, remote, and less dense areas (Q4-areas). These findings provide useful information at local and national levels and inform decisions about resource allocation to geographically targeted prevention and control plans to increase CRC screening and management.

Neighborhood socioeconomic status and the effectiveness of colorectal cancer screening outreach with mailed fecal immunochemical tests within a safety net healthcare system in San Francisco, CA: A subgroup analysis of a randomized controlled trial

Neighborhood context shapes opportunities and barriers for residents to access healthcare and cancer screening. Neighborhood socioeconomic status (nSES) is associated with disparities in colorectal cancer (CRC) screening, but the extent to which the effectiveness of specific screening interventions vary by nSES has not been studied. The original trial conducted in San Francisco, CA from 2016 to 2017 randomly assigned patients eligible for CRC screening either to a multicomponent intervention including advanced notification, mailed fecal immunochemical test (FIT) kits and reminders or to a control group receiving usual care. For the nSES analysis addresses for 9699 patients were geocoded and stratified by city-wide nSES quintile (Q1 lowest, Q5 highest) using an established index at the census tract level. Compared to usual care, the outreach intervention improved FIT test completion at one year (58.7% vs 38.4%; OR 2.32 [2.14, 2.52]) but its effectiveness did not vary substantially by nSES quintile (adjusted OR Q1 2.64 [2.30, 3.04]; Q2 2.43 [2.04, 2.90]; Q3 2.31 [1.84, 2.89]; Q4 2.47 [1.86, 3.28]; Q5 2.64 [1.83, 3.81]; Wald test for interaction p = 0.87). The implementation of mailed FIT outreach has the potential to increase CRC screening completion without leading to disparities in screening related to nSES (ClinicalTrials.gov NCT02613260).

Durability of FIT Screening After Cessation of a Screening Outreach Intervention

IntroductionOrganized outreach to increase CRC screening using mailed FIT tests has been shown to be effective, but durable changes to screening behavior after cessation of screening is not known.MethodsIn this study, after cessation of funding for an organized cancer screening outreach program, we evaluated whether adherence to screening remained elevated. Patients aged 50–75 years eligible for CRC screening from eight safety net clinics were randomly assigned to outreach intervention vs usual care alone in 2016 to 2018; the primary outcome analyzed was the difference in the cumulative proportion of completed FIT screening between study assignments 1 year after study cessation.ResultsDespite higher rates of FIT screening for patients who were randomly assigned to the outreach intervention, FIT completion was not significantly different between the group that received the outreach services versus the usual care group (28.3% vs 29.8%, p = 0.158).ConclusionOutreach campaigns and their activities must be sustained to maintain improved rates of screening participation.

Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans

BackgroundScreening for colorectal cancer (CRC) with faecal immunochemical test (FIT) is effective at reducing CRC mortality. Unfortunately, the COVID-19 pandemic has been associated with deferred care, especially screening for CRC.AimWe...

Socioeconomic and geographic inequalities in colorectal cancer in Cyprus: An ecological study

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The aim of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socio-economic inequalities in Cyprus for the periods between 2000 and 2015. Methods A small area ecological study in Cyprus, with census tracts as units of spatial analysis, for the period between 2000 and 2015. The incidence date, sex, age, post code, primary site, death date in case of death or last contact date in case of alive for all cases of CRC from 2000-2015 were obtained from the Cyprus Ministry of Health. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model. Results There are geographical areas having 15% higher SIR and SMR, with most of those areas located at the east coast of the island. Higher M/I ratio values were found in the rural, remote, and less dense areas of the island while lower rates were observed in the metropolitan areas. An inverted U-shape pattern in CRC incidence and mortality was observed with higher rates in the areas classified in the second quartile of the socio-economic deprivation index and lower rates in rural, remote, and less dense areas. A different pattern emerged in the M/I ratio indicating a stepwise increase across increasing levels of socioeconomic deprivation. Conclusions These findings can potentially provide useful information at local and national levels and can inform public health authorities to appropriately allocate resources for geographically targeted prevention and control plans to increase CRC screening. Key messages • M/I ratio of CRC was positively associated with regional deprivation since a stepwise increase was found across increasing levels of rural-related socioeconomic deprivation. • Interventions aimed at reducing the risks of CRC should primarily focus on socially deprived communities in Cyprus.