Initiation Of Colorectal Cancer Screening Research Articles

Should colorectal cancer screening guidelines account for gender and race/ethnicity?

1022 Objectives: The recommended age to begin colorectal screening is 50 for all Americans at “average” risk, regardless of gender or race/ethnicity. However, the natural history of colorectal cancer differs between men and women and across major racial/ethnic groups. Therefore the optimum starting age for colorectal screening may depend upon gender and race/ethnicity. We compare the total cost-effectiveness of different starting ages for colorectal screening by gender and race/ethnicity to address this issue. Methods: We determined age-specific colorectal cancer incidence rates, the proportion of left-sided cancers, and the proportion of localized cancers in Asian, Black, Latino, and White men and women using the California Cancer Registry. We incorporated these data and available data for life expectancy and colorectal cancer survival to model the cost-effectiveness of two 35-year colorectal cancer-screening interventions. Results: Age-specific colorectal cancer incidence rates were highest in Black men and lowest in Latino women. Screening beginning at age 50 was most cost-effective in Black men and least cost-effective in Latino women (measured as dollars spent per year of life saved) using annual fecal occult blood testing combined with flexible sigmoidoscopy every 5 years and using colonoscopy every 10 years. The cost-effectiveness of a 35-year screening program in Black men beginning at age 45 was similar to the cost-effectiveness of screening White men and Black women beginning at age 50 and more cost-effective than screening non-Black women as well as Asian and Latino men beginning at age 50. Conclusions: Screening is most cost-effective in Black men because of high age-specific colorectal cancer incidence rates. Initiation of colorectal cancer screening in this group prior to age 50 should be strongly considered, and could mimic prostate cancer screening recommendations in this high-risk group. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer

Community cancer control task forces in Rhode Island

1038 Background: Despite Rhode Island (RI) being a small State geographically, its population is strongly community centric. Recognizing this problem, cancer education and resources must address each community's needs. Methods: The State Legislature in 2000 recommended that Community Cancer Control Task Forces (CCCTF) be developed in each of the 39 cities and towns in RI and asked the Rhode Island Cancer Council (RICAN) to undertake this development. RICAN has been joined by the Department of Health and the American Cancer Society in this endeavor. Results: Today 14 CCCTF are in varying stages of development. Working with local government, RICAN has brought medical leadership and community hospitals into partnership with school committee members, senior housing, nursing organizations and voluntary agencies. The most developed CCCTF is in the city of Pawtucket, which has undertaken anti-tobacco programs and a colorectal cancer screening initiative. Conclusions: Each community's population differs by ethnic mix and has a different profile of cancer incidence and death rates. Therefore, programs are designed to meet specific local needs. Working with the task forces RICAN has presented educational programs at the local YMCA's, churches, health fairs, senior centers and schools. Outcome measures are in place so that the impact of community programs will be accessible. No significant financial relationships to disclose.

Patient and provider barriers to colorectal cancer screening in the primary care safety-net

Objectives. This study examines patient and provider barriers to screening for colorectal cancer among low-income uninsured African-Americans aged 50 years or older in an urban safety-net primary care clinic, with the goal of informing a future intervention. Methods. Four focus groups were conducted among 40 patients from, or living in the immediate neighborhood of, a primary care clinic for uninsured residents of Washington, DC. An additional focus group was conducted among primary care providers from the same clinic. Using semistructured open-ended questions, moderators elicited perceptions of barriers and promoters of colorectal cancer screening and suggestions to improve adherence to screening guidelines. The focus groups were audio-taped and transcribed verbatim. The transcripts were independently coded by two reviewers using established qualitative methodology. Results. Patient and provider comments from the five focus groups fell into one of eight content areas: primary care characteristics (36% of comments), procedural issues related to screening (16% of comments), knowledge (14% of comments), cost/insurance coverage (13%), ordering of priorities (12%), attitudes (5%), information sources (2%), and perceptions of discrimination (2%). Involving various members of the primary care team in colorectal cancer screening processes, and using reminders with feedback, were identified as promising avenues for future interventions in the safety-net setting. Patients and providers cited the lack of referral sources for colonoscopy for follow-up of abnormal fecal occult blood tests (FOBT), and lack of treatment sources as major barriers to the initiation of colorectal cancer screening in uninsured populations. Conclusions. Organizational level interventions, such as a team approach to colorectal cancer screening, are important areas identified for future colorectal cancer screening interventions in the safety-net primary care setting. Larger policy efforts to provide coverage for screening, diagnosis, and treatment among the uninsured are critical to implementing adequate colorectal cancer screening for this population.

Barriers to Fecal Occult Blood Testing and Sigmoidoscopy Among Older Chinese‐American Women

Purpose: This study examined factors associated with fecal occult blood test (FOBT) and sigmoidoscopy screening use among Chinese‐American women age 60 years and older.Description of study: One hundred women were recruited from senior centers in two metropolitan areas on the east coast of the United States. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, FOBT and sigmoidoscopy use, common and cultural barriers to colorectal cancer screening, and acculturation.Results: Logistic regression models found greater acculturation to be a significant predictor of having had a FOBT at least once, and found both greater acculturation and physician recommendation to be significant predictors of having had a sigmoidoscopy at least once. No significant predictors were found for regular adherence to colorectal screening guidelines, which include having undergone an FOBT in the past year and sigmoidoscopy in the past 5 years.Clinical implications: This study found that older Chinese‐American women underuse FOBT and sigmoidoscopy screening, as is recommended by the American Cancer Society colorectal cancer screening guidelines. These findings suggest that cultural factors may influence the initiation of colorectal cancer screening for Chinese‐American women but are not predictive of adherence to screening over time. Outreach efforts to promote colorectal cancer screening in this population might target women who are less acculturated to facilitate an initial entry into the Western healthcare system to obtain screening.

Barriers to fecal occult blood testing and sigmoidoscopy among older Chinese-American women.

This study examined factors associated with fecal occult blood test (FOBT) and sigmoidoscopy screening use among Chinese-American women age 60 years and older. One hundred women were recruited from senior centers in two metropolitan areas on the east coast of the United States. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, FOBT and sigmoidoscopy use, common and cultural barriers to colorectal cancer screening, and acculturation. Logistic regression models found greater acculturation to be a significant predictor of having had a FOBT at least once, and found both greater acculturation and physician recommendation to be significant predictors of having had a sigmoidoscopy at least once. No significant predictors were found for regular adherence to colorectal screening guidelines, which include having undergone an FOBT in the past year and sigmoidoscopy in the past 5 years. This study found that older Chinese-American women underuse FOBT and sigmoidoscopy screening, as is recommended by the American Cancer Society colorectal cancer screening guidelines. These findings suggest that cultural factors may influence the initiation of colorectal cancer screening for Chinese-American women but are not predictive of adherence to screening over time. Outreach efforts to promote colorectal cancer screening in this population might target women who are less acculturated to facilitate an initial entry into the Western healthcare system to obtain screening.