Colorectal Cancer Screening Options Research Articles

Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.

Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.

Stool-Based Colorectal Cancer Screening Test Performance Characteristics in Those With and Without Hemorrhoids

ObjectiveTo evaluate the effect of hemorrhoids on noninvasive stool test performance for colorectal cancer (CRC) screening. Patients and MethodsWe conducted a retrospective cohort study of test characteristics for the fecal immunochemical test (FIT) and the multitarget stool DNA (mt-sDNA) test, on the basis of hemorrhoid status, recorded at the time of colonoscopy, among patients enrolled in the pivotal prospective study for mt-sDNA that was conducted from June 2011, to May 2013. Test characteristics (sensitivity, specificity, positive, and negative predictive values) for FIT and mt-sDNA (performed < 90 days before colonoscopy) were stratified by the presence of hemorrhoids and compared. ResultsHemorrhoids were found in 51.7% (5163 of 9989) of the study cohort. Across all test characteristics, there were no statistically significant differences for FIT or mt-sDNA when stratified by hemorrhoid status. Analysis revealed mt-sDNA sensitivity of 44% and 41% for advanced precancerous lesions in nonhemorrhoidal and hemorrhoid patients, respectively (P=.41). The FIT sensitivity among the same lesion category was 24.9% in patients without hemorrhoids and 22.8% in those with hemorrhoids (P=.48). The mt-sDNA specificity was 86.4% in patients without hemorrhoids vs 87.7% in those with hemorrhoids (P=.67), although FIT specificity was 95.0% among patients without hemorrhoids vs 94.7% in those with hemorrhoids (P=.44). ConclusionThe presence of asymptomatic hemorrhoids did not adversely affect test performance in this large clinical study. These findings suggest that in the absence of overt gastrointestinal bleeding, FIT and mt-sDNA are options for CRC screening, irrespective of hemorrhoid status. Trial Registrationclinicaltrials.gov Identifier: NCT01397747

Addressing barriers to colorectal cancer screening in a federally qualified health center.

Colorectal cancer (CRC) is a leading cause of death from cancer in the United States, despite the availability of high-quality screening options. Multiple barriers to CRC screening have been identified, including cost (noninsured), younger age, racial or ethnic minority, recent immigration to the United States (non-English speaking), fear or distrust of the health care system, and rural residence. The mean CRC screening rate for the designated Federally Qualified Health Center (FQHC) was 33.7% for the 5 months preceding this quality improvement (QI) project. The benchmark target for CRC screening was 60.1%. The Model for Improvement and Plan-Do-Study-Act cycle created the framework for the CRC screening targeted interventions used in this FQHC patient population. Multiple targeted interventions were implemented over a 4-month period that emphasized a strong provider recommendation, a team-based approach to identify and offer CRC screening options to the overdue patient. A chart audit was followed by a mailed fecal immunochemical test (FIT) and colonoscopy reminder letter initiative. The performance metric for CRC screening reached 40% within 4 months. A second chart audit confirmed the CRC screening rate improved to 41.5% among patients aged 50-75 years. An overall 55% return rate was achieved with the mailed FIT initiative within 2 months. Continued quality improvement initiatives are needed to achieve the benchmark target for this FQHC. These team-based interventions can be used by the primary care nurse practitioner to improve health equity for CRC screening in other underserved populations.

Colorectal cancer screening with blood-based tests: Estimated impact of a 1-, 2-, or 3-year screening interval compared with annual FIT and triennial mt-sDNA strategies.

10580 Background: Blood-based tests are an emerging option for non-invasive colorectal cancer (CRC) screening for which the Centers for Medicare &amp; Medicaid Services (CMS) has proposed coverage every 3 years for average-risk individuals. Analyses with the CRC-AIM microsimulation model demonstrated that triennial screening with blood-based tests with CMS minimum performance often yields inferior outcomes to stool-based CRC screening (fecal immunochemical test [FIT] and multi-target stool DNA [mt-sDNA]). CRC-AIM was used to explore the impact of blood-based screening intervals, using reported performance characteristics from the ECLIPSE study (Guardant Health, Inc.)1, on estimated clinical outcomes vs FIT and mt-sDNA screening. Methods: Outcomes were simulated for average-risk individuals screened between ages 45-75 years. Intervals were set at 1, 2, or 3 years for blood-based, 3 years for mt-sDNA and annually for FIT screening. The blood-based test was modeled at 83% CRC sensitivity, 13% advanced adenoma sensitivity, and 90% specificity. Perfect adherence (100%) was modeled for blood-based tests and real-world adherence rates used for CRC initial screening tests (mt-sDNA=65.6%; FIT=42.6%) and follow-up colonoscopy (mt-sDNA=72.1%; FIT=46.0%). Primary outcomes were life-years gained (LYG) and colonoscopies (COL) per 1000 individuals for blood-based screening compared to mt-sDNA and FIT. As a secondary analysis, estimates were generated with perfect (100%) adherence assumed for initial screening and follow-up colonoscopy for mt-sDNA and FIT as well. Results: Blood-based testing at a 3-year interval with 100% adherence led to 11% fewer LYG than mt-sDNA at RWE adherence (240 vs 270, respectively), and 9% more COL (1402/1000 vs 1288/1000). Meanwhile, blood-based testing at a 1-year interval and perfect adherence (best case scenario) resulted in the lowest LYG per COL ratio across all scenarios (16% more LYG and 87% more COL compared to mt-sDNA at RWE adherence). Blood-based test results showed similar trends when compared to FIT. Conclusions: Outcomes for blood-based screening every 3 years based on reported test performance characteristics and unrealistic perfect adherence demonstrate fewer LYG as compared to either mt-sDNA or FIT. When compared to real-world adherence for mt-sDNA and FIT, blood-based tests with 1- and 2-year intervals and perfect adherence had higher LYG with the tradeoff of a greater number of diagnostic colonoscopies. [Table: see text]

Patient-provider communication factors associated with mt-sDNA screening for colorectal cancer.

e22514 Background: Several colorectal cancer (CRC) screening tests, shown to reduce CRC incidence and mortality, are recommended for average-risk adults aged 45-75 years. CRC screening is underutilized in the US with access to facility-based options, such as colonoscopy, representing a barrier to screening. Stool-based tests are guideline-endorsed and offer patients a convenient and more accessible CRC screening option that can be completed at home. Provider recommendation is consistently identified as the primary factor driving patient adherence. Understanding how aspects of patient-provider communication influence CRC screening can inform interventions to improve adherence. We developed a survey, informed by behavioral theory, to identify communication factors associated with completion of mt-sDNA screening. Methods: Adults aged 45-75 years, with a US postal address, who received a valid order for mt-sDNA and whose kit was shipped between 5/21-9/21 were eligible for sampling. The survey was administered by RTI International between 3/22-6/22. Participants could complete electronic or paper surveys. We fit a multivariable logistic regression to identify patient-provider communication factors associated with mt-sDNA test completion. Results: 2,973 respondents completed the survey (response rate = 21.7%). The majority (77.3%) completed the mt-sDNA test and said they would be ‘very likely’ (76.8%) to complete Cologuard in the future. The proportion of respondents who had conversations with their healthcare provider about Cologuard, and the specific content of those conversations, was significantly different between completers and non-completers and between respondents who said they were ‘very likely’ to complete Cologuard in the future compared to respondents who were not. Results from a binary logistic regression suggested that discussions with a healthcare provider related to step-by-step instructions for completing Cologuard (OR = 1.62) and needing to have a colonoscopy follow-up (OR = 1.93), as well as feeling included ‘a great deal’ in the decision-process with respondents’ healthcare provider (compared to ‘somewhat’ or ‘not at all’) increase the odds of kit completion. Additionally, healthcare provider discussions relating to test cost (OR = 1.47) and performance (OR = 1.72), as well as feeling included ‘a great deal’ in the decision-process was positively associated with respondents indicating they were ‘very likely’ to use Cologuard in the future. Provider discussions about the cost of a follow-up colonoscopy was negatively associated with a ‘very likely’ future user (OR = 0.52). Conclusions: Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

The impact of extending CRC screening to the older population: Results from CRC-AIM microsimulation model.

10567 Background: Average-risk screening for colorectal cancer (CRC) is effective and recommended. The U.S. Preventive Services Task Force issued grade A and B recommendations for screening ages 50-75 and 45-49, respectively, however the recommendation for the older population (ages 76-85) is grade C (moderate certainty that the net benefit is small). With emerging blood-based CRC screening, we evaluated the benefits of screening the older population with continued multi-target stool DNA (mt-sDNA) or FIT strategies and/or with a modality shift to blood-based tests after age 75. Methods: Using the validated CRC-AIM microsimulation model, triennial mt-sDNA and annual FIT screening (ages 45-75) followed by four strategies for ages 76-85 (no screening, continued mt-sDNA/FIT, or a modality shift to blood-based screening using either CMS criteria [CMS] or recently reported blood test data from the ECLIPSE study1 [BT; Guardant Health, Inc.] were considered. For CMS criteria and BT, CRC sensitivity were set at 74% and 83%; and adenoma sensitivity was set to 20%, and 13%; and CRC specificity was set to 90% for both tests. Real-world (RWE) adherence for initial screening was set to 80% (CMS, BT), 65.6% (mt-sDNA), and 42.6% (FIT). Adherence for follow-up colonoscopy was set to 72.1% (mt-sDNA, CMS, BT) and 46.0% (FIT). Results: Screening among the population aged 45-85 resulted in 281 life years gained (LYG) with continued mt-sDNA as compared to 193 with continued FIT. Furthermore, mt-sDNA reduced CRC mortality by 70% as compared to 49% by FIT (Table). When screening modality was shifted to CMS (76-85 year olds), mt-sDNA/CMS resulted in 279 LYG as compared to 196 for FIT/CMS. CRC incidence was reduced by 59% (mt-sDNA/CMS) as compared to 38% (FIT/CMS), and mortality declined by 69% (mt-sDNA/CMS) as compared to 51% (FIT/CMS). Reductions in disease burden were lower when modality was switched to BT after age 75 due to reduced test performance. Conclusions: Extending CRC screening to the older population with continued mt-sDNA demonstrated the best health outcomes compared to other modalities. A modality shift after age 75 to blood-based testing resulted in greater LYG as compared to no screening, with performance at CMS criteria yielding better results than BT. Therefore, despite inferior performance, blood-based tests may offer a CRC screening option for older patients who are unable to complete stool testing. [Table: see text]

CT colonography : Technique and indications

Dedicated radiological expertise and ahigh-quality examination, performed according to current technical standards and for accepted indications, are prerequisite to achieve excellent results with CT colonography (CTC). The aim of this article is to review current standards of the examination technique as well as indications and contraindications for CTC based on recent recommendations and guidelines. Based on extensive literature research, current knowledge about the examination technique and the indications and contraindications is summarized. CTC is the radiological examination of choice for the detection of colorectal neoplasia. Beside incomplete or refused colonoscopy and contraindications to colonoscopy, CTC is also anoninvasive option for opportunistic colorectal cancer screening. The examination technique is based on aCTC-specific patient preparation scheme that includes fecal tagging, colonic distension, low-dose CT scans in two patient positions and acombined 2D and 3D data evaluation. Performing CTC according to current technical standards is prerequisite for high-quality examinations and is, thus, also akey factor to obtain acorrect diagnosis. CTC is anoninvasive examination, capable of providing clinically relevant diagnoses for awide range of indications.

Abstract 770: Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control

Abstract Background: Multiple guideline-recommended colorectal cancer (CRC) screening options have been shown to reduce CRC incidence and mortality among average-risk patients. Yet, CRC screening continues to be underutilized in the US. Provider recommendation has consistently shown to improve screening completion. Our study aimed to delineate the pathways through which provider communication influences CRC screening completion. We tested how provider communication about the "Why” and “How” of mt-sDNA screening contributes to mt-sDNA screening intention through influencing patients’ screening outcome expectancies and perceived behavioral control. Methods: Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. The survey was administered between 3/22-6/22 by RTI International, with a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/21-9/21. Participants completed an electronic or paper survey. We measured patients’ reports of providers’ “Why” communication with items on mt-sDNA screening performance, advantages/disadvantages, and cost. Providers’ “How” communication was measured with items on instructions and need for follow-up testing. We tested the proposed relationships using structural equation modeling and tested indirect effects using bootstrapping. Results: A total of 2973 participants completed the survey (response rate: 21.7%). “Why” communication was positively associated with perceived effectiveness of mt-sDNA screening (b = 0.349, p &amp;lt; .001) and negatively associated with CRC worry (b = -0.078, p = .002). “How” communication was positively associated with perceived ease of use (b = 0.392, p &amp;lt; .001) and perceived comfort of mt-sDNA screening (b = 0.138, p &amp;lt; .001). Perceived effectiveness and perceived ease of use were positively associated with intention to complete mt-sDNA screening (b = 0.404, p &amp;lt; .001; b = 0.339, p &amp;lt; .001). “Why” communication contributed to screening intention through influencing perceived effectiveness (b-indirect effect = 0.141, 95% CI: 0.115, 0.177). “How” communication contributed to screening intention through influencing perceived ease of use (b-indirect effect = 0.133, 95% CI: 0.104, 0.172). Conclusions: Improving patients’ beliefs about the effectiveness and ease of use of screening may be one pathway through which provider communication contributes to CRC screening completion. Efforts are needed to develop and implement provider-patient communication strategies and toolkits that are efficacious at fostering patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients’ self-efficacy in completing their preferred screening option. Citation Format: Xuan Zhu, Paul Limburg, Linda Squiers, Leah Helmueller, Gabriel Madson, Brian Southwell, Carlye Gates, Shama Alam, Jennifer Laffin, Lila Finney Rutten. Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 770.

Psychosocial, behavioral, and communication factors associated with completion of the mt-sDNA test for colorectal cancer screening.

60 Background: Colorectal cancer (CRC) screening has been shown to reduce CRC incidence and mortality. Several CRC screening modalities are guideline recommended for average-risk adults aged 45-75 years. CRC screening is underutilized in the US and access to facility-based options, such as colonoscopy, represents a potential barrier. Home-based stool tests are guideline-endorsed and offer a convenient, accessible, scalable option for CRC screening. Thus, understanding the factors that influence completion of stool-based CRC screening is important to guide interventions to improve adherence. We developed a survey, informed by behavioral theory, to identify psychosocial, behavioral and communication factors associated with completion of mt-sDNA screening. Methods: The survey instrument was finalized through expert review, quality testing, and cognitive testing. Adults aged 45-75 years, with a US postal address, who received a valid order for mt-sDNA and whose kit was shipped between 5/21-9/21 were eligible for sampling. RTI administered the survey between 3/22-6/22. Participants had the option to complete electronic or paper surveys. We fit a multivariable logistic regression to identify factors significantly associated with mt-sDNA test completion. Results: Of 17,370 individuals invited to participate, 2,973 completed the survey (AAPOR RR3 = 21.7%); 77.3% of the sample completed the mt-sDNA test. Responders and non-responders did not differ significantly by sex or age. Controlling for demographic characteristics and insurance status, the odds of mt-sDNA test completion were significantly higher among participants who reported greater perceived test effectiveness (OR = 1.20), greater ease (OR = 4.06), and greater comfort in test use (OR = 1.18). Odds of test completion were significantly higher among participants who reported their healthcare provider discussed the mt-sDNA test with them (OR = 2.01) and involved them a great deal in decision making about CRC screening (OR = 1.29). Participants who expressed greater worry about developing CRC were less likely to return their mt-sDNA kit (OR = 0.81). Conclusions: To improve population adherence to CRC screening recommendations, efforts are needed to ensure patients understand the attributes and effectiveness of available test options and feel adequately prepared to complete their preferred screening test. Additionally, healthcare providers must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

SAFETY AND EFFECTIVENESS OF LEFT SIDE COLONOSCOPY OR SIGMOIDOSCOPY VERSUS TOTAL COLONOSCOPY IN PATIENTS LESS THAN 45 YEARS OLD AGE PRESENTED WITH THE PERIANAL DISEASE AT KURDISTAN CENTER FOR GASTROENTEROLOGY/SULAIMANIYAH

Background &#x0D; Colonoscopy and flexible sigmoidoscopy are recommended tools for diagnosing colorectal diseases, but their relative effectiveness needs to be clarified. Direct comparisons of colonoscopy and sigmoidoscopy in the same population would help inform patients, providers, and policymakers about patients presented with perianal features and colorectal cancer (CRC) screening options.&#x0D; Objectives &#x0D; To evaluate the ability of each of these two modalities (colonoscopy and sigmoidoscopy) to reach the diagnosis in patients presenting with features suggestive of perianal disease and to determine factors that predict safely performing left-sided colonoscopy in patients less than forty-five years old given with features suggestive of perianal disease. &#x0D; Materials and Methods&#x0D; This prospective cross-sectional study will be conducted between the 1st of January 2021 and the 1st of January 2022 in the department of KCGH (Kurdistan center for gastrointestinal and Hepatology) / Teaching- Hospital, Sulaymaniyah City, Iraq. One thousand patients presented with features (bright red bleeding per-rectum, blood on toilet tissue, pain and itching in anal region, anal soiling) of perianal disease were subjected to sigmoidoscopy and extended to full colonoscopy. The patients are divided into two groups, each group of 500 patients. The first group (basic group) includes patients younger than 45 years and the second group (comparison group) includes patients aged equally and more than 45 years.&#x0D; Results&#x0D; The mean age of the primary group is about 33 years. All patients underwent sigmoidoscopy and extended to total colonoscopy with terminal ileal intubation; in the basic group, we have 48 (4.8%) patients with left side polyps (10 large and 38 small polyps) and 16 (1.6%) right side polyps (2 large and 14 small polyps), in this group, we have only 6 (0.6%) patients with left side colonic mass and no cases of right side colonic mass, while in comparison group we have 115 (11.5%) cases with left side colonic polyp (27 large and 88 small polyps) and about 86 (8.6%) cases of right side colonic polyp, regarding detecting mass in this group we have 20 (2.0%) cases of left side colonic mass and 6 (0.6%) cases of right side colonic mass.. &#x0D; Conclusion&#x0D; Colonoscopy and sigmoidoscopy are important tools for investigating patients presenting with perianal features. While both are sensitive to detecting pathology in the left side of the colon, our study concluded that although colonoscopy is the ideal procedure for detecting lesions in the whole colon (proximal &amp; distal to splenic flexure), limited colonoscopy up to splenic flexure can be safely carried out in patients less than 45 years old presented with perianal diseases.

Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents.

Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on knowledge and perceptions of stool-based tests. Subsequent questions explored perceptions of different screening tests, CRC knowledge and beliefs, and trusted community locations for screening outreach. Transcripts were analyzed iteratively, and codes were derived inductively and refined to develop overarching themes. Participants experienced multilevel barriers to completing CRC screening. Primary themes about CRC screening included acknowledgment of importance, positive and negative personal experiences, need for increased outreach, and desire for greater cultural representation in educational materials. Participants frequently discussed perceptions of inadequate medical care, with most having only ever been offered colonoscopy; subsequently, knowledge of stool-based tests was low. To address this knowledge gap, participants stressed interpersonal communication from trusted individuals, such as local Black medical providers and CRC survivors. Given the low knowledge of stool-based testing among participants and identified inequities in receipt of clinical care, community-based CRC screening interventions are warranted to reduce Black-white CRC screening disparities.

Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a medicaid population

Colorectal cancer (CRC) is the third leading cause of cancer death in the US. Early detection improves CRC outcomes and multiple options are endorsed for CRC screening; however, adherence remains challenging. Among Medicaid enrollees, the fecal immunochemical test (FIT) is often used for average-risk CRC screening, with suboptimal adherence rates reported (12.3–23.2 %). The navigation-supported (personalized outreach by phone, mail, email and text), at home collection, multi-target stool DNA (mt-sDNA) test represents a relatively recent and broadly accessible option for average-risk CRC screening in Medicaid enrollees. We assessed cross-sectional mt-sDNA adherence in a national sample of Medicaid patients. Data from Exact Sciences Laboratories LLC (ESL; Madison, WI) were retrospectively analyzed. Participants included individuals 45 + years covered by Fee-For-Service (FFS)- or Managed-Medicaid. Primary analysis focused on the 50–74 age cohort and included those with valid mt-sDNA orders between January 1–December 31, 2018. Data from 25,794 individuals who received valid orders for mt-sDNA were included in analysis (61.2 % women; mean age at order 57.5 years). Overall adherence – completion of an ordered test – was 51.3 %. Adherence was 54.6 % in Managed-Medicaid and 38.9 % in FFS-Medicaid. Adherence by age was: 51.5 % for 50–64 years and 47.7 % for 65–74 years. Mt-sDNA tests ordered by gastroenterologists had higher adherence (60.5 %) compared with primary care clinicians (51.3 %). These data from a large, national sample of Medicaid-insured patients substantiate mt-sDNA testing as a viable patient-supported, home-based option to improve average-risk CRC screening participation in Medicaid enrollees.

S297 Missed Opportunities in Colorectal Cancer Screening Education: An Analysis of NCI-Designated Cancer Center Website Content

Introduction: The NCI-Designated Cancer Centers (NCC) are the authority on cancer education for both health care professionals and patients. These centers serve as the primary source of information and guidance for patients on current age-appropriate cancer screening guidelines. Due to a higher incidence of colorectal cancer (CRC) in younger adults, the American Cancer Society (ACS) has decreased the age at which to begin screening to 45 years-old in average risk adults. We aimed to analyze the websites of 71 NCC to determine whether or not these websites provide information on all possible screening modalities as well as if one screening modality is more emphasized than another. Methods: We reviewed the websites of 71 NCC and performed a content analysis. In particular, we recorded if each NCC website mentioned the following as options for CRC screening: high sensitivity FOBT, FIT, sDNA-FIT, colonoscopy, flexible sigmoidoscopy, flexible sigmoidoscopy with FIT, and computed tomography (CT) colonography. Special notation was made of NCC websites that discussed all possible screening modalities as well as risks and benefits of CRC screening. Results: In totality, of the 71 NCC websites, only 8.4% (6/71) mentioned all seven possible screening modalities. All 71 websites, however, specifically cited the role of colonoscopy in screening for CRC. In terms of non-invasive testing, 42.3% of NCC websites (30/71) discussed high sensitivity FOBT, 30.9% (22/71) discussed FIT, 28.2% (20/71) discussed sDNA-FIT, and 35.2% (25/71) discussed CT colonography. In terms of invasive testing aside from colonoscopy, 36.6% (26/71) cited flexible sigmoidoscopy as an option for CRC screening and 14.0% (10/71) cited flexible sigmoidoscopy with FIT. Conclusion: Overall, less than 10% of NCI-Designated Cancer Centers actually mention to all of the possible options for CRC screening on their websites, which represents a missed educational opportunity for both patients and health care professionals. As hypothesized, these websites primarily emphasize the role of colonoscopy in detecting CRC. Less than half of the NCC websites even referenced non-invasive testing options for CRC screening, which may be an important consideration for patients who are either high-risk for or unwilling to undergo a colonoscopy. We believe that educating patients about all of the various options for CRC screening may help increase screening adherence for CRC in the long-term.

S301 Patients Prefer Blood Based Screening Tests Compared With Current Options for Colorectal Cancer Screening in a Community-Based Confidential Survey

S301 Patients Prefer Blood Based Screening Tests Compared With Current Options for Colorectal Cancer Screening in a Community-Based Confidential Survey

The COMPASS study: A prospective, randomized, multi-center trial testing the impact of a clinic-based intervention informing patients of colorectal cancer screening options on screening completion

BackgroundColorectal cancer (CRC) screening is underutilized despite evidence that screening improves survival. Since healthcare provider recommendation is a strong predictor of CRC screening completion, providers are encouraged to engage eligible patients in collaborative decision-making that attends to patients' values, needs, and preferences for guideline-concordant screening modalities. MethodsThis three-arm randomized controlled trial is testing the effectiveness of an evidence-based video intervention informing patients of screening choices delivered in a clinic prior to a healthcare appointment. We hypothesize that participants randomized to watch a basic video describing CRC and screening in addition to an informed choice video showing the advantages and disadvantages of fecal immunochemical test (FIT), stool DNA FIT (s-DNA FIT), and colonoscopy (Arm 3) will exhibit a greater proportion of time adherent to CRC screening guidelines after 1, 3 and 6 years than those who only watch the basic video (Arm 2) or no video at all (Arm 1). Primary care and Obstetrician/Gynecology clinics across the United States are recruiting 5280 patients, half who have never been screened and half who previously screened but are currently not guideline adherent. Participants complete surveys prior to and following an index appointment to self-report personal, cognitive, and environmental factors potentially associated with screening. Proportion of time adherent to screening guidelines will be assessed using medical record data and supplemented with annual surveys self-reporting screening. ConclusionResults will provide evidence on the effectiveness of informational and motivational videos to encourage CRC screening that can be easily integrated into clinical practice.Clinicaltrials.gov #NCT05246839

Abstract 5938: Administering colorectal cancer education via an inflatable colon with the underrepresented and underserved population of Arizona

Abstract Background: The state of Arizona has a diverse population, with the Latino (31.7%) and American Indian/Alaskan Natives (AI/AN) (5.3%) populations higher than the national average of 18.5% and 1.3%, respectively. The colorectal cancer (CRC) screening rates among Latinos is 54.8% and AI/AN is 35%, compared to the overall Arizona screening rate of 62.6%, potentially contributing to higher CRC mortality rates in these groups. Objective: Utilizing an inflatable colon to measuring CRC knowledge and intent to screen among Arizona’s diverse populations by administering a pre/post test. Methods: An inflatable colon with signs in both English and Spanish describes the progression of CRC. Spanish-speaking health educators and culturally tailored flip charts geared toward the AI/AN population are utilized at community events throughout Arizona. Survey distribution measured pre- and post-CRC knowledge and intent to screen following a walking tour of the inflatable colon. Additional efforts include the production of a virtual tour of the giant colon in English and Spanish as an educational tool easily accessible on the UArizona Cancer Center YouTube page. Results: Convenience sampling is utilized, and participants are recruited at outreach events where the inflatable colon is set up (n=15). Preliminary findings show that individuals increased their knowledge about CRC (76.9% vs 100%), understanding the pathology of CRC (i.e., colon polyp, normal colon tissue vs. cancerous tissue, etc.) (53.8% vs 100%), and CRC screening recommendations (30.8% vs 91.7%). Conclusions: Colorectal cancer education is reaching diverse populations in Arizona. CRC education is delivered in both English and Spanish, and additional CRC educational tools such as the culturally tailored colon health flipbook for AI/AN population are utilize. The use of the inflatable colon has increased CRC knowledge, CRC pathology, and CRC screening options. Citation Format: Desiree Jones, Gabriela Ruiz, Juan Contreras, Rene D. Herrera, Amanda A. Lee, Monica Yellowhair, Jennifer Hatcher. Administering colorectal cancer education via an inflatable colon with the underrepresented and underserved population of Arizona [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5938.

Systematic Review of Colorectal Cancer Screening-Related Apps.

Background: In the United States, colorectal cancer (CRC) is the second leading cause of cancer death in men and women combined. The United States Preventive Services Task Force recommends that average risk adults have regular CRC screening to detect and prevent CRC. Despite published CRC screening guidelines, national CRC screening rates remain suboptimal. With the exponential increase in technology use and device ownership, many mobile health applications (apps) have been developed to improve health outcomes. There is great potential for smartphone or tablet apps to help improve CRC screening uptake, with the ultimate goal of reducing CRC morbidity and mortality. To date, there are no systematic reviews that have examined the publicly available, free apps that are related to CRC screening, and therefore, the quality and the content of these apps remain unknown. Objectives: The purpose of this study was to systematically review smartphone and tablet apps that could be used to improve CRC screening uptake. Methods: Apps available on the Google Play and Apple App stores that were compatible with smartphones and tablets were reviewed. Of the 2,790 apps reviewed, 20 met inclusion criteria. Results: Of the 20 apps that met inclusion criteria, most were informational in nature. Approximately half of the apps focused on colonoscopies and did not discuss other CRC screening options. Furthermore, more than half of the apps did not include video/audio content and the majority of the apps did not provide navigation support (e.g., reminders, instructions, maps). Conclusions: There are multiple free, publicly available apps that may encourage CRC screening uptake. Despite their promise, there is a paucity of empirical evidence evaluating the efficacy and usability of these apps. Future research efforts can evaluate the content, usability, accessibility, and potential impact of these apps.

Increasing Fecal Immunochemical Test Return Rates by Implementing Effective "Reminder to Complete Kit" Communication With Participants: A Quality Improvement Study.

BackgroundThe incidence of colorectal cancer (CRC) in the United States is increasing. It remains the second leading cause of cancer death in the United States for men and women combined, mainly due to underutilization of screening methods. The American Cancer Society now recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or structural (visual) examination, depending on patient preference and test availability. The primary objective of this quality improvement project was to determine if reminder methods, such as telephone or letter reminders, increased the return rate of fecal immunochemical tests (FIT) for CRC screening.MethodologyAt public outreach events and daily clinics in the West Texas Panhandle area, participants in the GET FIT program were provided with FIT kits after completing the education on CRC. Participants who fit the inclusion criteria and had received a FIT kit from the program were included. They were instructed on how to perform the test and mail it back. Participants who did not return the completed kits within two weeks were reminded either through (1) a reminder letter, (2) telephone, or (3) a combination of letter reminder and telephone call every two weeks (±three days) for 60 days or five attempts to contact. We de-identified and analyzed the FIT kit return data from April-September 2019 before analyzing these reminder methods. We then calculated the change in return rates from October 2019 to March 2020. Our goal was to increase the FIT return rates by 25% compared to the baseline return rate.ResultsThe pre-intervention return rate of kits for April-September 2019 was 61.52%, and the post-intervention return rate for October 2019-March 2020 was 71.85%. This rate was equal to an approximately 16.79% increase in return rates that was statistically significant (p < 0.01). There was a significant difference in the method of reminder between the two groups, but no significant differences in gender and race/ethnicity between the two groups. There was a significant difference in return rates between race/ethnicities in the October-March cohort with black and Hispanic participants having the highest return rates of 82.3% and 77.25%, respectively.ConclusionsFIT remains one of the primary options for CRC screening. Due to its lower cost and noninvasiveness, FIT was offered to patients at average risk. We demonstrated an increase in return rates, although we did not meet our target return rate goal for this project. This study was limited due to a gradual increase in coronavirus disease 2019 (COVID-19) cases and a subsequent shift and conversation of ongoing research into COVID-19.

Current and future colorectal cancer screening strategies.

Despite strong evidence of effectiveness, colorectal cancer (CRC) screening remains underused. Currently, there are several options for CRC screening, each with its own performance characteristics and considerations for practice. This Review aims to cover current CRC screening guidelines and highlight future blood-based and imaging-based options for screening. In current practice, the leading non-invasive option is the faecal immunochemical test (FIT) based on its high specificity, good sensitivity, low cost and ease of use in mailed outreach programmes. There are currently five blood-based CRC screening tests in varying stages of evaluation, including one that is currently sold in the USA as a laboratory-developed test. There are ongoing studies on the diagnostic accuracy and longitudinal performance of blood tests and they have the potential to disrupt the CRC screening landscape. Imaging-based options, including the colon capsule, MR colonography and the CT capsule, are also being tested in active studies. As the world attempts to recover from the COVID-19 pandemic and adapts to the start of CRC screening among people at average risk starting at age 45 years, non-invasive options will become increasingly important.

Colonoscopy Findings in FIT+ and mt-sDNA+ Patients versus in Colonoscopy-only Patients: New Hampshire Colonoscopy Registry Data.

Few studies compare fecal immunochemical test (FIT) and multi-target stool DNA (mt-sDNA) outcomes in practice. We compared colonoscopy yield following FIT+ or mt-sDNA+ tests to colonoscopies without preceding stool tests in the comprehensive population-based New Hampshire Colonoscopy Registry (NHCR). Outcomes were any neoplasia and an ordered outcome: adenocarcinoma, advanced neoplasia (adenoma/serrated polyp ≥ 1 cm/villous/high-grade dysplasia), nonadvanced neoplasia, or normal. Our total sample included 306 mt-sDNA+ (average age ± SD 67.0 ± 7.9), 276 FIT+ (66.6 ± 8.7), and 50,990 colonoscopy-only patients (61.8 ± 8.1). Among average-risk patients (N = 240 mt-sDNA+, N = 194 FIT+, N = 26,221 colonoscopy only), mt-sDNA+ patients had a higher risk for any neoplasia (67.1%) compared with FIT+ (54.6%, P = 0.00098) or colonoscopy (40.8%, P < 0.0001). Severity of findings and histology subtypes differed across the three groups (P < 0.0001 for both), with a higher yield of advanced findings in mt-sDNA+ patients. In particular, clinically relevant serrated polyps (hyperplastic polyps ≥10 mm/traditional serrated adenomas/sessile serrated polyps) were detected at a higher frequency in mt-sDNA+ patients as compared with FIT+ or colonoscopy-only patients. Even after adjustment, patients with positive mt-sDNA [OR = 2.82; 95% confidence interval (CI), 2.00-4.02] or FIT+ tests (OR = 1.67; 95% CI, 1.19-2.36) were more likely to have histologically more advanced findings than colonoscopy alone. At follow-up colonoscopy, mt-sDNA+ tests were more likely to predict neoplasia than FIT+, largely due to increased detection of serrated polyps. Prevention Relevance: Colorectal cancer screening options include colonoscopy and stool-based tests, including the fecal immunochemical test (FIT) and the multi-target stool DNA (mt-sDNA) test which, if positive, must be followed by a colonoscopy. Assessing "real-world" outcomes of colonoscopies following positive stool tests can inform their clinical use. See related Spotlight, p. 417.