National Colorectal Cancer Research Articles

Slovenian national colorectal cancer screening – Programme SVIT

Slovenian national colorectal cancer screening – Programme SVIT

Colonoscopy-related complications in a nationwide immunochemical fecal occult blood test-based colorectal cancer screening program.

BackgroundThe Danish national screening program for colorectal cancer (CRC) consists of an immunochemical fecal occult blood test (iFOBT) followed by colonoscopy. The Danish Colorectal Cancer Screening Database (DCCSD) records data on the incidence of hospital-registered complications after colonoscopy. However, the validity of these data is unknown, and the incidence of complications is potentially underreported.ObjectiveTo evaluate the validity of the colonoscopy complications registered in the DCCSD by using medical records as the reference. Further, to evaluate the incidence of complications leading to hospital contact.MethodsAmong 14,671 individuals with a positive iFOBT result and a colonoscopy procedure performed from March 3, 2014 to December 31, 2014, we selected 295 individuals for medical record review. We calculated sensitivity as the proportion of true complications registered in the DCCSD out of all complications found in the medical records, and the positive predictive value (PPV) as the number of true complications in the DCCSD out of all DCCSD-registered complications. On the basis of the medical record data, we calculated the incidence proportion of hospital-registered complications overall and by subtype.ResultsIn total, we reviewed 286 records and found 102 individuals with at least one complication. The sensitivity of the DCCSD for any complication was 29.4% (95% CI: 20.8–39.3) and the PPV was 88.2% (95% CI: 72.6–96.7). On the basis of the medical record data, the incidence proportion of any complication after colonoscopy was 0.70% (95% CI: 0.57–0.84) and that of perforation or lesion was 0.10% (95% CI: 0.06–0.17); bleeding, 0.41% (95% CI: 0.31–0.53); post-polypectomy syndrome, 0.16% (95% CI: 0.10–0.24); and other medical complications, 0.04 (95% CI: 0.02–0.09).ConclusionThe DCCSD has low sensitivity for complications, and improvements in data registration are warranted. The incidence proportion of any hospital-treated post-colonoscopy complication was 0.70% in 2014, which was the first year of the Danish national CRC screening program. This is within the range of complications reported by other studies.

An audit of performance, interpretation, and influence of pretherapeutic MRI in rectal cancer: a Swedish population-based cohort study.

Background The performance of magnetic resonance imaging (MRI) interpretation and communication of findings and its implication on treatment decisions has not fully been explored in rectal cancer. Purpose To investigate in a region the adherence to MRI protocol standards and the relation between MRI interpretation and selection to preoperative therapy in rectal cancer. Material and Methods Data on consecutive patients who underwent elective rectal cancer surgery in the region from January to June 2010 were obtained from the National Colorectal Cancer Registry. Pretherapeutic MRI images were re-evaluated. Agreement between the original reports and the re-evaluation was compared using Cohen’s kappa coefficient. Results Among the 94 patients included, 81 (86%) had pretherapeutic MRI in accordance with defined imaging guidelines. In 34% of the original MR reports, data on extramural venous invasion (mrEMVI) and mrT category were not reported. Complete tumor staging was not possible because of missing data in 33 (35%) of the patients. The agreement between the original MR reports and the re-evaluation regarding tumor stage was moderate (κ = 0.48). For decided treatment compared to recommended preoperative treatment according to the re-evaluation, the agreement was fair (κ = 0.33). Conclusion Established MRI protocol standards were not universally applied. Missing data and inadequacies in original MRI reports resulted in moderate agreement between the original report and the re-evaluation indicating a risk of inappropriate treatment selection. The results call for further educational efforts in rectal cancer MRI acquisition and repeated audits of image protocol adherence and interpretation quality.

Three years of colorectal cancer screening in Denmark

BackgroundThe Danish National Colorectal Cancer Screening Programme was implemented in March 2014 and is offered free of charge to all residents aged 50–74 years. The aim of this study is to compare performance indicators from the Danish National Colorectal Cancer Screening Programme to the recommendations from European Guidelines in order to assure the quality of the programme and to provide findings relevant to other population-based colorectal cancer screening programmes. MethodsBased on data from the Danish Colorectal Cancer Screening Database, we evaluated all performance indicators for which the European Guidelines provided acceptable level, desirable level or the level from first screening rounds in population-based studies using FIT. ResultsAll performance indicators were above the acceptable level and/or in line with the level from the first screening round in population-based studies using FIT. Whenever the European Guidelines provided a desirable level for a performance indicator, the Danish National Colorectal Cancer Screening Programme was close to or above this desirable level. ConclusionsCompared to the European Guidelines, all performance indicators were above the acceptable level and close to the desirable level. Based on these findings, the implementation of the National Danish Colorectal Cancer Screening Programme is considered a success and the programme is hopefully in the process of reducing colorectal cancer morbidity and mortality in Denmark.This study provides relevant information for comparisons to other population-based public service colorectal cancer screening programmes as well as for future revisions of guidelines.

Colorectal Carcinoma Below 50 Years of Age: A Data Review on The National Colorectal Cancer Data Registry

Background: Colorectal cancer remains a notable source of mortality and morbidity across the globe. It is the second commonest cancer in Malaysia. Robust screening program has exponentiated worldwide in last few decade especially in the western countries. Interestingly, there are more worrying reports of late to show that the incidence in younger patients, below 50 years of age are increasing. Aim: This study is aimed to look at clinical characteristics and survival outcome of this group in our local context. Methods: The National Colorectal Cancer Registry, The Northern Report 2008 - 2014 was reviewed retrospectively into the data to determine the number and clinical characteristics in patients with colorectal cancer in patients aged below 50 and in patients of 50 years and above. Results: A total of 3117 patients were included in the registry. 477 patients were younger than 50 years of age. Majority of the patients with colorectal cancer in the registry were from the Chinese ethnic group (59%), followed by the Malays (35%), Indian (5%) and others (1%). However, the younger patients' cohort seem to have more Malays diagnosed (54%), followed by the Chinese (36%), Indian (9%) and others (1%). Only 11% of the younger adults have family history of colorectal cancer. 68.1% of these patients, falls into the 40-49 age group. Sadly, majority of them (69.4%) are already in stage III or stage IV on presentation. The survival rate at 5 years however are significantly better in the younger patients with 45.49% as compared with the older group with 37.42% ( P = 0.015). Conclusion: Patients below 50 years with colorectal cancer presents with a different clinical characteristic as compared with the older patients. A review on a bigger national registry would be beneficial. Perhaps advocating a surveillance screening program for populations at an earlier age may be warranted in the future.

Saturday Screening Saves the Day!

Introduction: Colorectal cancer (CRC) is the second leading cause of all cancer related deaths in the USA. Data from 2015 reveals that only 60-63% of adults 50 years and older had CRC screening. The National CRC Roundtable in coalition with the American College of Gastroenterology aimed to increase the rates of CRC screening to 80% by 2018. The use of colonoscopy for screening is dependent on the availability of the physician and the endoscopy center. The demand for colonoscopies is on the rise, and for many individuals weekdays may not be a reasonable time to undergo a procedure. The aim of this study was to evaluate the impact of improved access to colonoscopy by offering Saturday screenings as it relates to polyp detection and examine patient preference for weekend availability. Methods: During CRC awareness month (March 2018), gastroenterologists at Allegheny Health Network offered weekend screening colonoscopies at eight outpatient endoscopy centers. A survey outlining patient demographics and opinions on weekend screening were collected. Pathology results and adenoma detection rates (ADR) were collected one week after procedure completion. Results: A total of 80 patients underwent a colonoscopy, of which 59 (74%) were female and 67 (84%) were Caucasian. The majority of patients (87.5%) stated they were more likely to have a colonoscopy when offered on a weekend, with 74% of patients preferring bowel preparation on Friday followed by a Saturday procedure. In addition, 41 (51%) patients stated their main cause of delaying their screening colonoscopy was due to weekday employment. Pathology results revealed that 54 (67%) patients had at least one polyp, of which 35 (49%) had an adenoma (26 tubular, 8 sessile serrated, and 1 tubulovillous adenoma). Surveillance intervals also changed to 5, 3, and 1 year for 29, 9, and 4 patients, respectively. Conclusion: CRC is one of the most preventable cancers if caught early in its course. Our study highlights that many individuals delay their screening colonoscopy due to their inability to take off work. Weekend availability offers greater access to colonoscopy which can help prevent CRC. Treatment can cost up to $30,000 per patient once diagnosed. In turn, the cost of a screening colonoscopy is approximately $3,000. Saturday screenings provide a substantial impact in the mission to provide high quality care, improve patient experience, and decrease overall healthcare costs.2755_A Figure 1. Results from our 8-Question Survey from Saturday Screenings (N=80)2755_B Figure 2. Number of Patients with Adenomas2755_C Figure 3. Types of Adenomas Found

Treatment and Survival From Colorectal Cancer in Denmark, England, Norway, and Sweden: A Population-Based Study

Background: Colorectal cancer (CRC) patients in Denmark and England have historically had worse outcomes than patients diagnosed in other high-income countries with similar healthcare coverage. This survival deficit may be partly explained by differences in stage distribution due to delays in cancer diagnosis, however, differences in stage-specific survival suggest that differences in treatment also explain the survival gap. Aim: We aim to provide a comparison of stage-specific survival of CRC patients diagnosed in Denmark, England, Norway and Sweden, and compare the probability of receiving potentially curative surgery (PCS) by patient and tumor characteristics to understand whether differences in stage and treatment help explain the international differences in survival. Methods: Population-based information on patients aged 18-99 years diagnosed with primary malignant colon or rectal cancer in Denmark, England, Norway, and Sweden during 2010-2012 was extracted from national CRC registries. We compared the prevalence of PCS by stage and age category, and estimated the probability of receiving it using multivariate logistic regression. Age-standardized net survival was estimated using a multivariable modeling approach. Results: There were 13,230 patients diagnosed with CRC in Denmark, 99,869 in England, 11,754 in Norway, and 17,584 in Sweden between 2010 and 2012. The proportion of patients with missing stage information was higher in England than in the other countries. Stage distribution was otherwise similar. Survival of patients with stage I-II tumors was generally comparable between the countries, but lower in England and - to a lesser degree - in Denmark for stage III-IV disease. Patients with unknown stage had lower survival than staged patients in all countries. We found marked disadvantages in the probability of receiving PCS in older patients with stage II-IV disease in England, and stage IV colon cancer patients in Denmark. The proportion of surgically-treated rectal cancer patients (and their survival) was comparable between Denmark, Norway and Sweden for each combination of age group and stage, except for patients diagnosed with stage I disease. The proportion of patients receiving surgery and survival from rectal cancer was generally lower in England. Conclusion: Denmark seems to be catching up with Norway and Sweden, especially in rectal cancer survival. Despite recent improvements, CRC survival in England remains lower than in Sweden and Norway. Survival generally paralleled countries' relative performance in the provision of potentially curative surgery. Differences in patient selection for surgery, especially in older patients and/or with advanced disease, may partly explain the survival deficit. Increases in the proportion treated, in combination with efforts in postoperative care and with other treatment modalities, may translate into better longer-term outcomes, especially for frail patients.

The Impact of a Health Care Delivery-Based Colorectal Cancer Screening Educational Session on the Perceptions and Knowledge Base of First Year Medical Students

Introduction: Current estimates show that 28% of US adults have never been screened for colorectal cancer (CRC), which has led the National CRC Roundtable to set goals of increasing screening rates to 80% by the end of 2018. In this study, we developed a replicable, 90 minute session to actively engage first year medical students in understanding the importance of CRC screening and their impressions of patient, physician, health-care systems, and community barriers to screening. Methods: A 90 minute session was developed for first year medical students. Prior to each session, a pre-program-survey on Qualtrics software was sent to the entire first year class at Albany Medical College (n= 134). A reading to illustrate the impact of CRC and the importance of barriers to screening was provided to learners prior to the session. The session consisted of a case presentation of a patient who was diagnosed with colon cancer, a presentation by the New York State Department of Health on the burden of CRC, a student group project and discussion of student project ideas, and a question and answer session with a panel of health-care professionals (including a gastroenterologist, public health physicians, and a community center director). Students were sent a post-survey and results were compared in aggregate to pre-survey data. Results: Based on pre- (n=55) and post- (n=41) program surveys, learners improved their ability to correctly identify the 80% target rate of average risk patients that should be screened for CRC (29.09% vs. 73.17%). Learners cited a ‘lack of knowledge’ (36.59%) as the largest patient barrier to receiving CRC screening, followed by ‘fear’ (28.63%), ‘access to care’ (17.07%), and ‘motivation’ (9.76%). Out of the 134 students who rated the educational activity, the majority rated the activity as good or excellent (74.63 %). Conclusion: This educational intervention for first year medical students was effective in informing students about the importance of CRC screening. In addition, this provided an opportunity for future physicians to discuss patient, physician, health-care system, and community barriers to care. By educating medical students on the importance of preventive screening, we hope to encourage future physicians to employ these methods in their practices to reduce the impact of preventable cancers. Further research is needed to improve student-based interventions and to assess the long-term impact of these sessions.

An international survey-based study on colorectal cancer pathology reporting—guidelines versus local practice

Different guidelines for colorectal cancer (CRC) pathology reporting have been published. We aimed to identify differences between publicly available CRC reporting guidelines and to survey pathologists from different countries to establish the degree of guideline implementation in local routine practice. We compared all core and non-core items of CRC reporting guidelines to identify discrepancies. We then created a survey, which was sent out to 782 pathologists practicing in 30 different countries. It included questions on the demographics of the reporting pathologist as well as resection specimen handling and microscopic evaluation, grading, staging, and additional techniques, such as immunohistochemistry or molecular pathology. First, core and non-core items of five national CRC reporting guidelines were compared and 12 items were found to differ. Different items are considered core or non-core by different guidelines and more than one TNM staging edition was applied across guidelines. The survey was completed by 143 pathologists from 30 countries. We identified differences between local practice and guidelines with potential clinical impact, e.g., tumor budding was never reported by 28.7% of responders, although it has prognostic value for survival in stage II CRC. This is the first international study comparing CRC pathology reporting guidelines with real-world local practices. There are differences in CRC pathology reporting guidelines and in guideline implementation into local practice, both with potential impact on patient care. Harmonization of datasets, use of templates, and audits of local pathology practice are needed to ensure best possible quality of CRC pathology reporting.

PCN8 - Factors Associated with Effectiveness of Population-Based Colorectal Cancer Screening

Colorectal cancer screening is a cost-effective method to reduce incidence and mortality. In a population-based setting, many factors may contribute to the performance of screening. This study investigated factors that influence the quality of cancer screening. The national colorectal cancer screening by biennial faecal occult blood test has been implemented since 1992 in Taiwan. In this study, we linked the colorectal cancer screening database (2010-2014) with Cancer Registry and Death Registry (till 2015). Possible influencing factors during screening progress were identified. The outcome variables included detection rate, proportion of early stage diagnosis and survival rates. The logistic regression and Cox regression were adopted to identify and to estimate factors for outcome performance. About 5.26 million screenings were performed during 2010-2014. Among them, 7.7% were referred for positive results of occult blood tests, of which 64.7% were further confirmed by colonoscopy. The second phase results showed that colorectal cancer, polyps accounted for 3.7% and 49.3%, respectively. Of the 9341 records found in the cancer registration, 66.2% (6448 records) were in stages 1-2. Higher detection rates of colorectal cancer and polyps were in males (3.8%), hospitals (3.5%), elderly (3.5% or above), and people with family history for colorectal cancer (3.3%). Referred patients who actually complete colonoscopy had a lower risk of death than no referral cases, while in the screening results was colorectal cancer (OR=0.49, 95%CI=0.45-0.54). We identify that age, family history, hospital and local health center in current cancer screening program are associated with higher detection rates or lower mortality. Our results can contribute to a future risk-stratified modification of our current colorectal cancer screening.

Colorectal Cancer Screening Participation Among Asian Americans Overall and Subgroups in an Integrated Health Care Setting with Organized Screening.

BackgroundScreening reduces colorectal cancer deaths, but <50% of Asian Americans are screening up-to-date according to surveys, with variability across Asian subgroups. We examined colorectal cancer screening participation among Asian Americans overall and Asian subgroups in a large integrated health care system with organized screening.MethodsData were electronically accessed to characterize screening in 2016 for Asians overall and subgroups relative to the National Colorectal Cancer Roundtable target of ≥80% screening and compared with non-Hispanic whites. Screening up-to-date was defined as a colonoscopy with 10 years, a sigmoidoscopy within 5 years, or a fecal immunochemical test (FIT) completed in 2016.ResultsAmong 436,398 patients, 69,826 (16.0%) were Asian, of whom 79.8% were screening up-to-date vs. 77.6% of non-Hispanic whites (p < 0.001). Almost all subgroups met the 80% target: Chinese (83.3%), Vietnamese (82.4%), Korean (82.1%), other Asian (80.3%), Filipino (78.7%), Asian Indian (79.6%), and Japanese (79.0%). Among Asians overall and non-Hispanic whites, 50.6% and 48.4% of members were up-to-date with screening by colonoscopy, and 28.0% and 28.2% were up-to-date by FIT, respectively. Across Asian subgroups, colonoscopy most frequently accounting for being screening up-to-date (range: 47.4–59.7%), followed by FIT (range: 21.6–31.5%).ConclusionsIn an organized screening setting, there were minimal differences in screening participation among Asian subgroups and almost all met the 80% screening target, despite differences in language preference. Screening test type differences across subgroups suggest possible preferences in screening modality, which can inform future research into tailored education or outreach.

Impact of a higher fecal immunochemistry test cut-off on pathology detected in subsequent rounds of a colorectal screening program

Fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening is superior to the traditional binary fecal occult blood test. Its quantitative nature allows the investigator to choose a positivity threshold to match cost and endoscope capacity. The optimal threshold is still debated. BowelScreen, the Irish national colorectal cancer screening program, has a cut-off of 45 μg Hb/g feces, and in this study we investigated the impact of this threshold on pathology detected in round 2 in individuals who had a negative result for round 1 FIT (FIT1). All individuals with a negative FIT1 result who completed a round 2 FIT (FIT2) 2 years later were included. Pathology outcomes for individuals who had positive FIT2 results were correlated with FIT1 levels. A total of 37,877 individuals had negative FIT1 results and completed FIT2. One thousand two hundred thirty (3.2%) had positive FIT2 results (702 men [57%], median age 69, age range 60-70 years). Quantitative analysis showed that at an FIT1 level<5 μg Hb/g feces, 2.3% had positive FIT2 results. At a higher cut-off of 40.1 to 45 μg Hb/g feces, 15.6% of individuals had positive FIT2 results. One thousand two (81.5%) underwent colonoscopy, with clinical outcomes in all cases. Three hundred fifty-one (35%) had normal colonoscopy results. The proportion of individuals with normal colonoscopy results decreased as FIT1 levels rose. Conversely, advanced pathology (CRC+ high-risk adenomas) rates rose from 7% to 50% when FIT1 was<5 compared with 40.1 to 45 μg Hb/g feces, respectively. There were 51 screen-detected cancers in round 2among individuals with negative FIT1 results (22 stage I, 12 stage II, 14 stage III, 3 stage IV). All 3 stage IV individuals had FIT1 results<20 μg Hb/g feces. Varying rates of pathology are observed in round 2 of a screening program based on the quantitative level of a negative round 1 FIT result when the positivity threshold is relatively high. A CRC rate of 5.1% within this group appears acceptable. Although patients with incurable cancer were observed, the positivity threshold to capture these cases within round 1 would have been so sensitive that it would create an unsustainable endoscopy referral burden.

Routine Molecular Analysis for Lynch Syndrome Among Adenomas or Colorectal Cancer Within a National Screening Program

It is important to identify individuals with Lynch syndrome because surveillance programs can reduce their morbidity and mortality from colorectal cancer (CRC). We assessed the diagnostic yield of immunohistochemistry to detect Lynch syndrome in patients with advanced and multiple adenomas within our national CRC screening program. We performed a prospective study of all participants (n= 1101; 55% male; median age, 66 years; interquartile range, 61-70 years) referred to the Erasmus MC in The Netherlands after a positive result from a fecal immunohistochemical test, from December 2013 to December 2016. Colon tissues were collected from patients with advanced adenomas, ≥4 nonadvanced adenomas, or CRC, and analyzed by immunohistochemistry to identify patients with loss of mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, or PMS2): a marker of Lynch syndrome. Specimens from patients with loss of MLH1 were analyzed for MLH1 promoter hypermethylation. Patients with an MMR-deficient tumor or adenoma without MLH1 promoter hypermethylation were referred for genetic analysis. At colonoscopy, 456 patients (41%) (65% male; mean age, 67 years; interquartile range, 63-71 years) were found to have CRC and/or an adenoma eligible for analysis by immunohistochemistry. Of 56 CRCs, 7 (13%) had lost an MMR protein and 5 had hypermethylation of the MLH1 promoter. Analyses of tumor DNA revealed that 2 patients without MLH1 promoter hypermethylation had developed sporadic tumors. In total, 400 patients with adenomas were analyzed. Of the examined adenomas, 208 (52%) had a villous component and/or high-grade dysplasia: 186 (47%) had a villous component and 41 (10%) had high-grade dysplasia. Only 1 adenoma had lost an MMR protein. This adenoma was found to have 2 somatic mutations in MSH6. In a CRC screening program in The Netherlands for individuals aged 55 to 75 years, routine screening for Lynch syndrome by immunohistochemistry analysis of colon tissues from patients with advanced and multiple adenomas identified no individuals with this genetic disorder.

Equivalent Accuracy of 2 Quantitative Fecal Immunochemical Tests in Detecting Advanced Neoplasia in an Organized Colorectal Cancer Screening Program

Although different brands of fecal immunochemical tests (FITs) are used for colorectal cancer (CRC) screening, few studies have compared their accuracy in detecting advanced neoplasia. We performed a large prospective cohort study within the Dutch national CRC screening program to evaluate 2 quantitative FITs: FOB-Gold (Sentinel, Milan, Italy) and OC-Sensor (Eiken Chemical, Tokyo Japan), from May 2016 through March 2017. We randomly selected 42,179 screening-naïve individuals (55-75 years old), who were asked to perform both FITs themselves using the same bowel movement. Participants with positive results from 1 or both FITs (≥15 μg hemoglobin/gram feces) were invited for colonoscopy examination (reference standard). Equivalence in detection of advanced neoplasia was evaluated with a predefined margin of 0.15%. Of 42,179 invitees, 22,064 (52%) participated and FITs were completed for 21,078 participants. Of 2112 participants (9.6%) with 1 or 2 positive results from FITs, 1778 (84%) underwent a colonoscopy. Of all invitees, the FOB-Gold test detected advanced neoplasia (confirmed by colonoscopy) in 610 participants (1.45%) and the OC-Sensor detected advanced neoplasia (confirmed by colonoscopy) in 606 participants (1.44%)-an absolute difference of 0.01% (95% confidence interval [CI], -0.06% to 0.08%). Of the 21,078 participants who completed both FITs, 1582 (7.5%) had a positive result from the FOB-Gold test and 1627 (7.7%) a positive result from the OC-Sensor test (P= .140). The relative true-positive rate of FOB-Gold vs OC-Sensor in detecting advanced neoplasia was 0.97 (95% CI, 0.92-1.01) and 0.95 (95% CI, 0.87-1.03) for CRC. The relative false-positive rate of the FOB-Gold test vs the OC-Sensor test in detecting advanced neoplasia was 0.99 (95% CI, 0.93-1.05). In a large prospective study of individuals invited for CRC screening in The Netherlands, we found equivalent accuracy of the FOB-Gold FIT vs the OC-Sensor FIT in detecting advanced neoplasia. These results are relevant for selecting FITs for CRC screening programs worldwide. Dutch National Trial Registry: NTR5874.

Abstract C11: Development of a tailored interactive multimedia intervention (TIMI) to promote colorectal cancer screening among Puerto Ricans

Abstract Introduction: Colorectal cancer (CRC) is the second-highest incident cancer among men and women in Puerto Rico (PR); however, CRC screening (CRCS) rates remain low. Data from the 2014 Behavioral Risk Factor Surveillance System indicate that only 18.5% of the PR population 50+ years has undergone an FOBT within the past two years compared to 12.8% in the United States of America (USA). Additionally, only 50.6% of age-eligible Puerto Ricans report ever having a sigmoidoscopy or colonoscopy compared to 68.8% in the USA. At a national level, the goal established by the National Colorectal Cancer Round Table is to reach a CRCS rate of 80% for 2018. Improving educational and interventional strategies to promote behavioral changes and screening uptake can help increase CRCS rates in the island. The Community Preventive Services Task Force (the community guide) recommends the adoption of interventions that use small media based on strong evidence of their effectiveness in increasing colorectal cancer screening by fecal occult blood test (FOBT); yet there is no sufficient evidence for sigmoidoscopy or colonoscopy. Using Intervention Mapping (IM), the Puerto Rico Community Cancer Control Outreach Program of the UPR/MDACC Partnership for Excellence in Cancer Research developed a self-directed tailored interactive multimedia intervention (TIMI) aimed to increase CRCS in Puerto Ricans. Objective: Develop a TIMI entitled ¡Salud! por la Vida, aimed to increase CRCS among non-adherent men and women 50 years and older in FQHCs in Puerto Rico. Methods: We developed a series of tailored colorectal cancer screening messages that were both culturally and linguistically appropriate. First, the concept and flow of the TIMI was developed. The concept includes subject matter, length, and user interface. Then, the script and storyboard were created to produce a prototype that was tested within the Community Advisory Group (CAG) and community members to obtain feedback on cultural relevance and linguistics. The script was adapted according to recommendations and fictional content, including acted scenes and testimonies, and animations were produced. The TIMI was beta tested for sequence, interface, and graphics. During the beta test, the application was scrutinized for errors or missing elements. The final TIMI consists of brief interactive videos that are tailored by variables considered relevant for CRCS (e.g., perceived risk, family history, among others) and will be delivered using tablets. Results and Conclusions: This innovative educational intervention using technology and developed from a guiding framework will help increase CRCS among men and women nonadherent to CRCS visiting FQHCs in Puerto Rico. To test the efficacy of this program on CRCS completion, we will conduct a randomized behavioral intervention trial in 10 FQHC clinics island wide. Note: This abstract was not presented at the conference. Citation Format: Camille Velez-Alamo, Adrianna I. Acevedo-Fontanez, Vivian Colon-Lopez, Marievelisse Soto-Salgado, Yolanda Serra-Martinez, Ileska M. Valencia-Torres, Maria E. Fernandez. Development of a tailored interactive multimedia intervention (TIMI) to promote colorectal cancer screening among Puerto Ricans [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C11.

Utilizing Federally Qualified Health Centers in Milwaukee to decrease colorectal cancer disparities.

e18611Background: In 2014, the National Colorectal Cancer Roundtable established a goal to screen 80% of adults, aged 50-75 for colorectal cancer (CRC) by 2018. In that year, 74% of Wisconsin adult...

Mo1640 - Perceptions and Beliefs of Invitees to Round 1 of the Irish National Colorectal Cancer Screening Programme

Mo1640 - Perceptions and Beliefs of Invitees to Round 1 of the Irish National Colorectal Cancer Screening Programme

Waiting for diagnostic colonoscopy: a qualitative exploration of screening participants' experiences in a FIT-based colorectal cancer screening program.

BackgroundParticipants in population-based screening for colorectal cancer (CRC) may experience increased anxiety immediately after a positive screening test, but research in this area is limited. The objective of this study was to explore how screening participants experience a positive test result and cope with the pre-diagnostic waiting period in a CRC screening program.Materials and methodsScreening participants with a positive fecal immunochemical test (FIT) result were identified in the Danish national CRC program before they attended diagnostic colonoscopy. Sixteen screening participants were selected for an interview in their own homes, using a semi-structured interview guide. Transcribed data were analyzed thematically.ResultsThe most prominent themes were symptom appraisal and communication strategies. Most participants attributed the positive FIT result showing blood in the stool to pre-existing non-malignant conditions but a few were very worried about the FIT result and the outcome of the colonoscopy. Communication strategies included discussions with family or friends about the positive FIT result and the upcoming colonoscopy, or containing information until the colonoscopy had provided the definitive diagnostic result. There was no apparent need for communication with health care professionals during the pre-diagnostic waiting period.ConclusionThe pre-diagnostic waiting period between positive FIT result and colonoscopy in a population-based screening program may cause worry for some participants, potentially to require support, but most people consider it unconcerning. Screening providers should communicate to all screening participants in written form that negative emotional responses may occur after a positive screening result. This is particularly important in screening programs using self-sample kits without the presence of a health care professional to reassure the few participants who may experience significant anxiety.

Impact of differences in adenoma and proximal serrated polyp detection rate on the long-term effectiveness of FIT-based colorectal cancer screening

BackgroundBoth the adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) vary among endoscopists. It is unclear how these variations influence colorectal cancer (CRC) screening effectiveness. We evaluated the effect of variation in these detection rates on the long-term impact of fecal immunochemical test (FIT) based screening.MethodsThe Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model was set up to simulate the Dutch national biennial FIT-based CRC screening program between 2014 and 2044. Adherence to FIT and colonoscopy was 73 and 92%. Besides a ‘no screening scenario’, several screening scenarios varying in ADR and PSPDR were evaluated. Using the available literature on colonoscopy miss rates led to a base-case ADR of 59% and PSPDR of 11%, which were varied with intervals of 3 and 2%.ResultsCompared to no screening, FIT-screening in the base-case scenario reduced long-term mortality with 51.8%. At a fixed PSPDR of 11%, an increase in ADR from 44 to 62% would result in a 10.7% difference in mortality reduction. Using a fixed ADR of 59%, changing the PSPDR from 3 to 15% did not substantially influence long-term mortality (51.0 to 52.3%).ConclusionsAn increase in ADR gradually reduces CRC burden in a FIT-based screening program, whereas an increase in PSPDR only minimally influences long-term outcomes at a population-level. The limited effect of the PSPDR can be explained by the limited sensitivity of FIT for serrated polyps (SPs). Other triage modalities aiming to detect relevant SPs should be explored.

Primary care colorectal cancer screening correlates with breast cancer screening: implications for colorectal cancer screening improvement interventions.

ObjectiveNational colorectal cancer (CRC) screening rates have plateaued. To optimize interventions targeting those unscreened, a better understanding is needed of how this preventive service fits in with multiple preventive and chronic care needs managed by primary care providers (PCPs). This study examines whether PCP practices of other preventive and chronic care needs correlate with CRC screening.MethodsWe performed a retrospective cohort study of 90 PCPs and 33,137 CRC screening-eligible patients. Five PCP quality metrics (breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control) were measured. A baseline correlation test was performed between these metrics and PCP CRC screening rates. Multivariable logistic regression with clustering at the clinic-level estimated odds ratios and 95% confidence intervals for these PCP quality metrics, patient and PCP characteristics, and their relationship to CRC screening.ResultsPCP CRC screening rates have a strong correlation with breast cancer screening rates (r = 0.7414, p < 0.001) and a weak correlation with the other quality metrics. In the final adjusted model, the only PCP quality metric that significantly predicted CRC screening was breast cancer screening (OR 1.25; 95% CI 1.11–1.42; p < 0.001).ConclusionsPCP CRC screening rates are highly concordant with breast cancer screening. CRC screening is weakly concordant with cervical cancer screening and chronic disease management metrics. Efforts targeting PCPs to increase CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact and success.