Screening-eligible Adults Research Articles

Abstract C67: Colorectal cancer screening in rural and frontier communities: The FluFIT on the Frontera Project

Abstract The prevalence of colorectal cancer screening among people living in Texas-Mexico, rural/frontier Border communities and colonias is not well characterized. While colorectal cancer screening in the Border region is 30%, among Hispanics, FOBT screening in the prior 2 years is 9.4%, and 59% of screening eligible adults have never had endoscopy (Texas BRFSS 2010). The FluFIT on the Frontera project, a colorectal cancer screening project for average risk people, was adapted from the evidence based FluFIT curriculum and implemented in a rural/frontier community setting to increase colorectal cancer screening. The project provides education, screening, early detection and treatment through community and regional partnerships. It targets Hispanic and underserved men and women aged 50-75 years of age who reside in the rural/frontier communities of Del Rio Texas and the surrounding colonias. Methods Clinic based providers and certified male and female promotores from Val Verde Regional Medical Center and QUAD Counties Promotoras Program, respectively, received formal didactic and implementation training for the FluFIT intervention. Participants received colorectal cancer screening education and FluFIT test process instruction from trained staff in the clinical setting and promotores in the community setting. Clinic and community based navigators provided participant navigation to insure timely receipt of specimens for analysis and follow-up. Participants who did not have a primary care provider were assigned to a provider in the Val Verde Regional Medical Center primary care clinic. All test results were provided to participants by either their assigned or private primary care providers. An integrated clinic and community based provider, navigator and project partnership assured referral for appropriate services as needed for positive tests. Results In the first 7 months of community programming 3743 community members were educated in either group or individual settings. Of these, 1959 adults (789 males, 40%; 1170 females) aged 50-75 years were evaluated for screening. Seventy five percent self-identified as white Hispanic and 25% as non-Hispanic. 753 met the screening eligibility criteria and 1206 did not. Of 753 (38.4%) who were screening eligible, 563 (74.8%) received FIT kits. Among 342 kits (60.7%) that were returned, 14 (12.57%) were positive. Colonoscopy was completed in 79% of patients with a positive FIT test and polyps were identified in 7. No cancers were diagnosed. Average and high risk participants accounted for 58.8% and 41.2% of people who were ineligible for screening. Among ineligible average risk participants 659 (80.3%) had prior screening. Among 575 high risk patients, 199 (34.6%) reported no prior screening. Prior screening accounted for 74.1% of participant ineligibility overall irrespective of risk stratification. Conclusions The FluFIT intervention is being successfully implemented in a rural/frontier community. The high proportion of males recruited to this study suggests that male promotores positively impact male recruitment. Colorectal cancer screening in this rural/frontier population is higher than previously reported in BRFSS and approaches that of the Border region (30%). The increased prevalence of participants who are high risk for colorectal cancer is a surprising finding that merits further investigation to better understand the population risk. Citation Format: Thelma C. Hurd, Ceci Lozano, Simon Sotelo, Samantha Adame, Raquel Rodriguez, Hector Guerra, Thankam Sunil. Colorectal cancer screening in rural and frontier communities: The FluFIT on the Frontera Project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C67.

Abstract B25: Black-white differences in colorectal cancer screening and incidence over time by age and sex

Abstract Introduction: Blacks have the highest colorectal cancer (CRC) burden of any racial/ethnic group and the underlying reason for this disparity has not been fully elucidated. Continued examination of incidence in relation to screening, which is recommended for men and women beginning at age 50 years, may provide valuable insights into these disparities. The present study examined black-white differences in CRC incidence and screening patterns by age and sex over time. Methods: National Health Interview Surveys between 2000-2015 were used to estimate screening prevalence and prevalence ratios (PR) among adults 50 years and older by non-Hispanic white/black race and sex. Data from the SEER were used to estimate age-sex-specific incidence rates from 1992-2013. Results: From 2000 to 2015, CRC screening prevalence in age 50 years and older increased by 69% in whites (from 39.4% to 66.5%) and by 98% in blacks (from 31.1% to 61.4%) on a relative scale. Increases in CRC screening were evident in both men and women. During this time period, black-white differences also narrowed, such that CRC screening in blacks was 19% lower than in whites in 2000 (PR=0.81, 95%CI 0.71,0.92) but only 6% lower in 2015 (PR=0.94, 95%CI 0.88, 1.00). Absolute black-white differences in CRC incidence rates were slightly larger for men than for women (men: 3.0-6.0 versus women: 2.8-5.4 per 100,000) in people 35-49 years old, but decreased overtime in both groups. In 50-79-year-olds, absolute black-white incidence differences were larger for men prior to 2003 (men: 19.8-28.9 versus women: 28.3-33.1 per 100,000) and during 2004-2013 (men: 27.7-53.3 versus women: 20.6-38.7 per 100,000). In 35-49-year-olds, black-white incidence rate ratios (IRR) decreased overtime from 1992-2000 to 2009-2013 in both men (1.47 to 1.19) and women (1.49 to 1.17), but increased in both men (1.06 to 1.38) and women (1.15 to 1.49) for those 50 years and older. Conclusions: Black-white differences in CRC incidence in both absolute and relative terms are greatest in screening-eligible adults and have persisted in recent years whereas absolute differences in incidence in those younger than 50 are relatively small. These patterns may reflect racial gaps in screening uptake. However, disparities in CRC screening prevalence have narrowed in recent years and may portend convergence in CRC incidence rates. Note: This abstract was not presented at the conference. Citation Format: Stacey A. Fedewa, Douglas Corley, Ahmedin Jemal, Rebecca Siegel, Michael Goodman, Chyke Doubeni. Black-white differences in colorectal cancer screening and incidence over time by age and sex. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr B25.

Text-message reminders in colorectal cancer screening: a non-clinical randomised controlled trial

BackgroundIn England, adults aged 60–74 years are eligible for colorectal cancer screening using a guaiac faecal occult blood test (gFOBt) kit. However, uptake of the gFOBt kit in London has been consistently below the national target. We investigated the effectiveness of a text-message reminder to improve uptake of the test kit in London. MethodsGeneral practices in six Clinical Commissioning Groups (CCGs) in London were invited to take part in this randomised controlled trial. Between Jan 18 and March 14, 2016, screening-eligible adults were randomised (1:1, using a pseudorandom number generator) to the control group (gFOBT screening pathway in the English Bowel Cancer Screening Programme [usual care]) or intervention group (usual care plus a text-message reminder). Individuals in the intervention group who had not returned their screening kit were sent a reminder text-message on the eighth week of an 18 week gFOBt screening episode. The primary outcome was the total proportion of individuals returning the kit by 18 weeks, which was determined with intention-to-treat analysis. Ethics approval was given by the East Midlands National Research Ethics Service (15/EM/0159) and the Confidentiality Advisory Group (15/CAG/0156). This trial is registered with ISRCTN, number ISRCTN70904476. Findings141 (48%) of 295 general practices participated, and 8269 individuals were randomised (4135 usual care, 4134 intervention). Only 49% of individuals in both groups had registered a mobile number with their practice (n=4089). In the intervention group, 1393 individuals with a registered mobile had not returned their test kit within 8 weeks; reminder text-messages were successfully delivered to 1026 individuals (74%), of whom 189 (18%) subsequently took part in screening. Intention-to-treat analysis showed that uptake was 40% (1648 of 4135) in the control and 41% (1674 of 4134) in the intervention group (odds ratio 1·04, 95% CI 0·95–1·13; p=0·43). Pre-planned exploratory subgroup analyses showed no effect on uptake by sex, index of deprivation, age, or CCG. However, a 6 percentage point difference in uptake was seen among individuals receiving an invitation for the first time (control 35% [282/809] vs intervention 41% [297/733]) (odds ratio 1·31, 95% CI 1·00–1·71; p=0·03). InterpretationText-message reminders did not significantly increase the number of adequately screened individuals in London. Future research might however investigate the potential efficacy of text-messages among individuals invited for screening for the first time. FundingLondon North West Healthcare NHS Trust.

Text Reminders in Colorectal Cancer Screening (TRICCS): Protocol for a randomised controlled trial.

BackgroundScreening with the guaiac faecal occult blood test (gFOBt) is associated with improved colorectal cancer (CRC) survival, and is offered biennially to men and women aged 60–74 years in England’s national Bowel Cancer Screening Programme (BCSP). Uptake of the gFOBt is low, with only 54 % of the eligible population completing the test. Text-message reminders could improve uptake of gFOBt.Methods/designThis paper describes the protocol for a randomised controlled trial, which will examine the effectiveness of a text-message reminder to promote uptake of gFOBt screening in the BCSP. Individual mobile telephone data from 180 general practices in London with existing mobile-health services will be linked to the national BCSP information system via a secure on-line network. All screening-eligible adults registered with a participating practice will be randomised, to receive either usual care (N = 1600) or usual care plus a text-message reminder to self-complete and return their kit eight weeks after their initial invitation (N = 1600). The primary outcome will be the proportion of individuals who return an adequately completed gFOBt kit within 18 weeks of the initial invitation. Differences in uptake between groups will be evaluated using a logistic regression analysis, adjusting for individual-level and area-level socio-demographic variables.DiscussionThis will be the first large-scale randomised trial of a text-message reminder in a national screening programme for CRC. If effective, this study provides a cost-effective means to promote uptake of CRC screening in an organised programme.Trial registrationCurrent Controlled Trials ISRCTN70904476 (18/09/2015).

FOBT Completion in FQHCs: Impact of Physician Recommendation, FOBT Information, or Receipt of the FOBT Kit

To determine the effect of common components of primary care-based colorectal cancer (CRC) screening interventions on fecal occult blood test (FOBT) completion within rural and urban community clinics, including: (1) physician's spoken recommendation, (2) providing information or education about FOBTs, and (3) physician providing the FOBT kit; to determine the relative effect of these interventions; and to compare the effect of each intervention between rural and urban clinics. We conducted structured interviews with patients aged 50 years and over receiving care at community clinics that were noncompliant with CRC screening. Self-report of ever receiving a physician's recommendation for screening, FOBT information or education, physician providing an FOBT kit, and FOBT completion were collected. Participants included 849 screening-eligible adults; 77% were female and 68% were African American. The median age was 57; 33% lacked a high school diploma and 51% had low literacy. In multivariable analysis, all services were predictive of rural participants completing screening (physician recommendation: P = .002; FOBT education: P = .001; physician giving FOBT kit: P < .0001). In urban clinics, only physician giving the kit predicted FOBT completion (P < .0001). Compared to urban patients, rural patients showed a stronger relationship between FOBT completion and receiving a physician recommendation (risk ratio [RR]: 5.3 vs. 2.1; P = .0001), receiving information or education on FOBTs (RR: 3.8 vs 1.9; P = .0002), or receiving an FOBT kit from their physician (RR: 22.3 vs. 10.1; P = .035). Participants who receive an FOBT kit from their physician are more likely to complete screening.