US Multi-Society Task Force Research Articles

Improving Colorectal Cancer Screening via Mailed Fecal Immunochemical Testing in a Veterans Affairs Health System.

Colorectal cancer screening rates at the Veterans Affairs Connecticut Healthcare System (VACHS) decreased during the COVID-19 pandemic. Fecal immunochemical testing is recognized as a tier 1 preferred screening method by the US Multi-Society Task Force on Colorectal Cancer. The VACHS implemented a program that mailed fecal immunochemical testing kits to patients to improve colorectal cancer screening rates. This article describes the components of the VACHS patient aligned care team-based mailed fecal immunochemical testing program. Fecal immunochemical testing utilization, completion, and colorectal cancer screening rates at VACHS substantially increased after the implementation of this project. Through a proactive, population-based colorectal cancer screening program centered on mailed fecal immunochemical testing kits outside of a traditional patient visit, VACHS substantially increased the utilization of fecal immunochemical testing kits as well as colorectal cancer screening rates.

Provider Adherence to the 2020 US Multi-Society Task Force Guidelines for Surveillance After Colonoscopy With Polypectomy

Background and AimsThe 2020 United States Multi-Society Task Force on Colorectal Cancer guidelines for surveillance after colonoscopy with polypectomy introduced significant changes in surveillance intervals. We sought to identify rates of adherence to these new guidelines at an academic medical center. MethodsAverage-risk screening colonoscopies where 1-4 polyps <10 mm were removed between 1/1/2020 and 6/30/21 were included. To determine predictors of non-adherence, a multivariable logistic regression analysis was conducted and included patient and procedure-related variables. Bayesian changepoint analysis was applied to identify timing of change in adherence. Multinomial logistic regression was used to identify predictors of variability within the guidelines. Results1,026 procedures were analyzed. Adherence to the guidelines was 85%. In procedures with 1-2 polyps, increasing size (OR 0.84 per mm; 95% CI: 0.75 - 0.93) and a mixture of tubular adenomas (TA) and hyperplastic polyps (HP) (OR 0.35; 95% CI: 0.21 - 0.59) were associated with non-adherence. Among procedures with 1-2 TAs, age (OR 0.86 per 5-year increase; 95% CI: 0.75 - 0.99), increasing size (OR 0.86 per mm; 95% CI: 0.75 - 0.99) and polyp number (OR 0.54; 95% CI: 0.33-0.90) were associated with non-adherence. Changepoint analysis identified a potential changepoint on 2/9/20 (95% credible interval 2/4/2020-2/22/2020). Larger TAs were less likely to receive a 10 year recommendation (OR 0.61, 95% CI 0.5 – 0.75). ConclusionAdherence rates to the 2020 surveillance guidelines were high with a potential changepoint identified on 2/9/20. Deviation from guidelines was associated with patient and procedure related variables.

ChatGPT4 Outperforms Endoscopists for Determination of Postcolonoscopy Rescreening and Surveillance Recommendations

Large language models including Chat Generative Pretrained Transformers version 4 (ChatGPT4) improve access to artificial intelligence, but their impact on the clinical practice of gastroenterology is undefined. This study compared the accuracy, concordance, and reliability of ChatGPT4 colonoscopy recommendations for colorectal cancer rescreening and surveillance with contemporary guidelines and real-world gastroenterology practice. History of present illness, colonoscopy data, and pathology reports from patients undergoing procedures at 2 large academic centers were entered into ChatGPT4 and it was queried for the next recommended colonoscopy follow-up interval. Using the McNemar test and inter-rater reliability, we compared the recommendations made by ChatGPT4 with the actual surveillance interval provided in the endoscopist's procedure report (gastroenterology practice) and the appropriate US Multisociety Task Force (USMSTF) guidance. The latter was generated for each case by an expert panel using the clinical information and guideline documents as reference. Text input of de-identified data into ChatGPT4 from 505 consecutive patients undergoing colonoscopy between January 1 and April 30, 2023, elicited a successful follow-up recommendation in 99.2% of the queries. ChatGPT4 recommendations were in closer agreement with the USMSTF Panel (85.7%) than gastroenterology practice recommendations with the USMSTF Panel (75.4%) (P < .001). Of the 14.3% discordant recommendations between ChatGPT4 and the USMSTF Panel, recommendations were for later screening in 26 (5.1%) and for earlier screening in 44 (8.7%) cases. The inter-rater reliability was good for ChatGPT4 vs USMSTF Panel (Fleiss κ, 0.786; 95% CI, 0.734-0.838; P < .001). Initial real-world results suggest that ChatGPT4 can define routine colonoscopy screening intervals accurately based on verbatim input of clinical data. Large language models have potential for clinical applications, but further training is needed for broad use.

Endoscopic treatment of colorectal polyps and early colorectal cancer

Background: Colonoscopy offers higher diagnostic sensitivity than other colorectal cancer screening methods and provides the advantage of both diagnostic tissue sampling and polyp removal. Since the majority of colorectal cancers evolve from adenomatous polyps, polyp resection through colonoscopy is widely considered an effective method of preventing colorectal cancer and reducing mortality rates.Current Concepts: Determining colorectal polyp size and shape requires comprehensive endoscopy with enhanced imaging techniques to choose treatment directions and the appropriate colorectal polypectomy method. The selection of the polypectomy method is contingent upon the polyp’s attributes and possible malignancy according to US Multi-Society Task Force on Colorectal Cancer and European gastrointestinal endoscopy guidelines. This article examines eight polypectomy procedures: cold forceps polypectomy, hot biopsy polypectomy, cold snare polypectomy, hot snare polypectomy, endoscopic mucosal resection (EMR), and modified EMR techniques. Each method has unique benefits and is suitable for particular polyp types and sizes. Piecemeal EMR and endoscopic submucosal dissection offer alternatives for larger or challenging lesions that require careful planning and follow-up. After endoscopic resection of early colorectal cancer, further surgery may be necessary depending on the risk of lymph node metastasis as determined by specific histologic findings following Korean and Japanese guidelines.Discussion and Conclusion: The choice of endoscopic resection technique, which depends on factors such as polyp shape, size, and location as well as endoscopist skill, is crucial for ensuring complete polyp removal.

Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines

Background: The risk of metachronous advanced neoplasia is linked to the presence of polyps on initial colonoscopy. Consequently, it is crucial to establish an appropriate colonoscopy surveillance period post-polypectomy.Current Concepts: The US Multi-Society Task Force, the European Society of Gastrointestinal Endoscopy, and the British Society of Gastroenterology revised their respective foreign guidelines in the 2020s. In Korea, a revised edition of post-polypectomy colonoscopic surveillance was announced in 2022, with the following risk factors: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesions containing any grade of dysplasia; (7) serrated polyps of at least 10 mm in size; and (8) 3 to 5 (or more) sessile serrated lesions. In these guidelines, suitable surveillance periods are suggested for each risk factor.Discussion and Conclusion: The evidence supporting the best practices for post-polypectomy colonoscopy surveillance has strengthened, helping to support both close follow-up for some populations and less intense follow-up for others.

Summary and comparison of recently updated post-polypectomy surveillance guidelines.

Recently, updated guidelines for post-polypectomy surveillance have been published by the U.S. Multi-Society Task Force (USMSTF), the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE), the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), and the Korean Multi-Society Taskforce Committee. This review summarizes and compares the updated recommendations of these 5 guidelines. There are some differences between the guidelines for the recommended post-polypectomy surveillance intervals. In particular, there are prominent differences between the guidelines for 1-4 tubular adenomas < 10 mm with low-grade dysplasia (nonadvanced adenomas [NAAs]) and tubulovillous or villous adenomas. The USMSTF, JGES, and Korean guidelines recommend colonoscopic surveillance for patients with 1-4 NAAs and those with tubulovillous or villous adenomas, whereas the BSG/ACPGBI/PHE and ESGE guidelines do not recommend endoscopic surveillance for such patients. Surveillance recommendations for patients with serrated polyps (SPs) are limited. Although the USMSTF guidelines provide specific recommendations for patients who have undergone SPs removal, these are weak and based on very lowquality evidence. Future studies should examine this topic to better guide the surveillance recommendations for patients with SPs. For countries that do not have separate guidelines, we hope that this review article will help select the most appropriate guidelines as per each country's healthcare environment.

S376 Provider Recommendation Adjustment to 2020 US Multi-Society Task Force on Colorectal Cancer Guidelines for Surveillance After Colonoscopy with Polypectomy for 3-4 Non-Advanced Adenomas

S376 Provider Recommendation Adjustment to 2020 US Multi-Society Task Force on Colorectal Cancer Guidelines for Surveillance After Colonoscopy with Polypectomy for 3-4 Non-Advanced Adenomas

What do ‘false-positive’ stool tests really mean? Data from the New Hampshire colonoscopy registry

We utilized the population-based New Hampshire Colonoscopy Registry to calculate false discovery rates (FDR) and positive predictive values (PPVs) using three ‘positive’ colonoscopy definitions. Understanding the frequency of meaningful ‘true positive’ mt-sDNA and Fecal Immunochemical Test (FIT) results can optimize the use of these colorectal cancer (CRC) screening tests. We calculated FDR (positive stool test followed by negative colonoscopy divided by all positive stool tests) and PPV for mt-sDNA and FIT cohorts using the following definitions:1) DeeP-C Study (CRC, adenomas/serrated polyps ≥ 1 cm, villous/High Grade Dysplasia);2) < 10 year US Multi-Society Task Force (USMSTF) follow-up: DeeP-C findings & ≥1 sessile serrated polyps (SSPs) < 1 cm (with/without dysplasia) or ≥ 1 tubular adenomas < 1 cm.3) Clinically Significant: DeeP-C + USMSTF + clinically significant serrated polyps: traditional serrated adenomas, SSPs, hyperplastic polyps (HPs) > 1 cm, and 5–9 mm proximal HPs.The sample included 549 mt-sDNA + and 410 FIT + and patients (mean age 66.4, 43.0% male). Using the most limited definition of positive colonoscopy, DeeP-C, FDR was 71.9% for mt-sDNA + and 81.7% for FIT +. Using the USMSTF definition, FDR decreased substantially: mt-sDNA+:33.2% and FIT+:47.6%. Adding all CSSPs resulted in the lowest FDR: mt-sDNA+:32.2% and FIT+:47.1%. Decreasing FDRs corresponded to increasing PPVs: mt-sDNA+:28.1% and FIT+:18.3% (DeeP-C definition) and mt-sDNA+:67.8% and FIT+:52.9% (DeeP-C + USMSTF + CSSP) (Table 1).FDRs decreased substantially when the definition of positive exams included all significant precancerous findings. These data present a comprehensive understanding of false positive outcomes at colonoscopies following positive stool tests, which to our knowledge is the first such analysis.

Frequency of endoscopic photodocumentation of large colorectal polyps

Colonoscopy quality affects colorectal cancer (CRC) incidence and mortality. The U.S. Multi-Society Task Force on Colorectal Cancer strongly recommends photodocumentation (PD) of lesions ≥10mm in size (ie, large polyps [LPs]) pre-resection and suggests PD postresection to enhance the quality of colonoscopy. No studies have assessed the frequency of LP PD. We evaluated the frequency of and factors associated with PD of LPs. Reports from endoscopists performing≥50 colonoscopies with LP resection between 2016 and 2021 were reviewed. The frequency of LP PD pre-resection and post-resection and factors associated with PD were collected. A composite score of 2 quality metrics (PD of completeness of examination and bowel preparation quality) was created. Endoscopists were divided into 2 tiers based on the frequency of the score on all included examinations: Tier 1,≥95% of examinations; and Tier 2,<95% of examinations. Univariate and multivariate analyses were used to assess factors associated with PD. A total of 1322 colonoscopies, 1693 LPs, and 25 endoscopists were included in this study. PD of LPs occurred in 1392 (82%) pre-resection and in 878 (52%) post-resection. Factors associated with pre-resection PD include endoscopist subspecialty (colorectal surgery vs gastroenterology: odds ratio [OR], .12; 95% confidence interval [CI], .04-.42); >1 LP on examination (2 vs 1 LP: OR, .41 [95% CI, .27-.61]; and≥3 vs 1 LP: OR, .41 [95% CI, .24-.70]), and longer withdrawal time (OR, 1.02; 95% CI, 1.01-1.04). We provide the first data on PD of LP pre-resection and post-resection, which can inform future benchmarking in this area. The implications of PD on metachronous advanced neoplasia need to be studied.

Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision

The risk of developing metachronous advanced neoplasia is associated with the presence of polyps in index colonoscopy. Therefore, it is essential to establish the optimal colonoscopy surveillance period following polypectomy. In the 2020s, international guidelines published by the US Multi-Society Task Force, European Society of Gastrointestinal Endoscopy, and British Society of Gastroenterology were revised. In 2022, the Korean postpolypectomy colonoscopic surveillance guidelines were revised to recommend surveillance for adenoma size ≥ 10 mm, ≥ 3 adenomas, tubulovillous or villous adenoma, adenoma with high-grade dysplasia, traditional serrated adenoma, sessile serrated lesion (SSL) with dysplasia, serrated polyp with size ≥ 10 mm, and ≥ 3 SSLs.

Use of surveillance colonoscopy among individuals with removal of high-risk polyps according to the US Multi-Society Task Force recommendations.

Individuals with colorectal polypectomy are recommended to undergo surveillance colonoscopies at certain intervals to prevent subsequent colorectal cancer. Use of postpolypectomy surveillance according to the 2006 US Multi-Society Task Force (USMSTF) recommendations in an integrated health care system was investigated. Use of surveillance colonoscopies was prospectively assessed among 3691 patients with removal of high-risk polyps at a screening colonoscopy during 2007-2012 in the Mass General Brigham Colonoscopy Cohort. With the follow-up up to 2017, the compliance with, overuse, and underuse of postpolypectomy surveillance according to the 2006 USMSTF recommendations was assessed. Surveillance use according to demographic factors was also investigated. During a median follow-up of 4.4years (5thpercentile, 95thpercentile, 1.0, 9.9) 2360 (64%) patients had undergone a surveillance colonoscopy, among whom 758 (21%) were considered compliant with the USMSTF recommendations. A substantial underuse of surveillance colonoscopies of 62% was observed. Older age and lower income were associated with a higher incidence of underuse, whereas having a family history of colorectal cancer were associated with lower incidence of underuse. Overuse of surveillance colonoscopies was present in 17% of patients but showed no significant associations with demographic factors. Substantial underuse of surveillance in patients with high-risk polypswasobserved, particularly those with low income and older age. Efforts are needed to improve delivery and use of surveillance colonoscopy. The US Multi-Society Task Force recommends follow-up surveillance colonoscopy after polyp removal in the bowel, with intervals depending on the most severe findings. Adherencetosurveillancerecommendationsin a large study with up to 10years of follow-up among patients with high-risk polyps was investigated. Only 21% of patients adhered to the surveillance recommendations, whereas 62% showed delayed or no use of surveillance. Findings highlight the need for improved use of surveillance colonoscopy among patients at high risk of colorectal cancer.

The Impacts of Computer-Aided Detection of Colorectal Polyps on Subsequent Colonoscopy Surveillance Intervals: Simulation Study.

Computer-aided detection (CADe) of colorectal polyps has been shown to increase adenoma detection rates, which would potentially shorten subsequent surveillance intervals. The purpose of this study is to simulate the potential changes in subsequent colonoscopy surveillance intervals after the application of CADe in a large cohort of patients. We simulated the projected increase in polyp and adenoma detection by universal CADe application in our patients who had undergone colonoscopy with complete endoscopic and histological findings between 2016 and 2020. The simulation was based on bootstrapping the published performance of CADe. The corresponding changes in surveillance intervals for each patient, as recommended by the US Multi-Society Task Force on Colorectal Cancer (USMSTF) or the European Society of Gastrointestinal Endoscopy (ESGE), were determined after the CADe was determined. A total of 3735 patients who had undergone colonoscopy were included. Based on the simulated CADe effect, the application of CADe would result in 19.1% (n=714) and 1.9% (n=71) of patients having shorter surveillance intervals, according to the USMSTF and ESGE guidelines, respectively. In particular, all (or 2.7% (n=101) of the total) patients who were originally scheduled to have 3-5 years of surveillance would have their surveillance intervals shortened to 3 years, following the USMSTF guidelines. The changes in this group of patients were largely attributed to an increase in the number of adenomas (n=75, 74%) rather than serrated lesions being detected. Widespread adoption of CADe would inevitably increase the demand for surveillance colonoscopies with the shortening of original surveillance intervals, particularly following the current USMSTF guideline.

Potential Impact of Extending Surveillance Intervals for Patients With 1-2 Low-Risk Adenomas.

Potential Impact of Extending Surveillance Intervals for Patients With 1-2 Low-Risk Adenomas.

Adherence to Recommendations for Repeat Surveillance After Publication of New Postpolypectomy Guidelines.

The 2012 and 2020 US Multi-Society Task Force postpolypectomy guidelines have recommended progressively longer surveillance intervals for patients with low-risk adenomas (LRAs). These guidelines require data from past colonoscopies. We examined the impact of the 2012 guidelines for second surveillance on clinical practice, including the availability of prior colonoscopy data, with the aim of informing the implementation of the 2020 guidelines. We identified surveillance colonoscopies at Stanford Health Care and the Palo Alto Veterans Affairs Health Care System in 3 periods: preguideline (March-August 2012), postguideline (January-June 2013), and delayed postguideline (July-September 2017). We collected data on the most recent previous colonoscopy, findings at the study entry surveillance colonoscopy, and recommendations for subsequent surveillance. Among 977 patients, the most recent prior colonoscopy data were available in 78% of preguideline, 78% of postguideline, and 61% of delayed postguideline cases (P < .001). The fraction of surveillance colonoscopy reports that deferred recommendations awaiting pathology increased from 6% to 11% in preguideline and postguideline to 59% in delayed postguideline cases (P < .001). Overall adherence to guidelines for subsequent surveillance was similar in all 3 periods (54%-67%; P= .089). In the postguideline and delayed postguideline periods combined, a 10-year subsequent surveillance interval was recommended in 0 of 29 cases with LRA followed by normal surveillance colonoscopy. In patients undergoing surveillance, prior colonoscopy data were not always available and recommendations were often deferred awaiting pathology. Adherence to subsequent surveillance guidelines was suboptimal, especially for LRA followed by normal colonoscopy. Strategies addressing these gaps are needed to optimize implementation of the updated 2020 postpolypectomy guidelines.

Post-Colonoscopy Colorectal Cancer Etiologies in a Large Integrated US Health Care Setting

Post-Colonoscopy Colorectal Cancer Etiologies in a Large Integrated US Health Care Setting

Accurate Determination of Colorectal Polyp Counts Is Not Mission Impossible for Pathologists and Is Essential for Surveillance Interval Decision-Making: A Review of 1294 Specimens

Abstract Introduction/Objective The US Multi-Society Task Force on colorectal cancer updated recommendations in 2020 for follow-up after colonoscopy. This emphasized differential surveillance intervals based on the number of polyps removed. We determined how often we accurately counted the number of polyps and what submission practices allowed accurate quantification. Methods/Case Report We reviewed consecutive colorectal polyp cases from 10/1 to 12/31, 2019, excluding inflammatory polyps in inflammatory bowel disease. Pathology reports were reviewed to determine if the polyp number could be determined from history, gross description, and histologic findings. When numbers did not match or were unclear, endoscopy reports and glass slides were reviewed. Results (if a Case Study enter NA) 601 cases with 1294 specimens were identified. We accurately determined polyp number in 1235 (95.4%) specimens. 1072 (82.8%) specimens were submitted as single polyp per container (SP), while 222 (17.2%) were submitted with &amp;gt; 1 polyp per container (MP). Polyp number was not quantifiable in 58 (26.1%) MP due to 11 labeled as “multiple polyps” in requisition/endoscopy reports and 47 submitted with polyp number different from number of tissue portions seen grossly and microscopically. In 1 (0.1%) SP, polyp number was unclear because separate portions of tissue contained two different diagnoses. Rate of accurate polyp count is significantly different between SP and MP (p&amp;lt;0.01) by Fisher exact test. Conclusion We accurately determined number of polyps in most specimens (95.4%) because our gastroenterologists usually submit SP. In MP, polyp count in 26.1% of specimens was unquantifiable. This could lead to uncertainty in surveillance follow-up intervals. Therefore, we recommend submitting one polyp per container.

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

S280 Appropriateness of Scheduled 5-Year Colorectal Cancer Surveillance Colonoscopies at an Academic Medical Center

Introduction: Prudent adenoma detection and family history assessment results in increased surveillance colonoscopies for colorectal cancer screening (CRC), where recommended intervals for follow-up colonoscopies are based on prior colonoscopy findings (i.e., polyp number, size, pathology) as well as family history. Previous studies based on retrospective electronic health data determined that surveillance colonoscopies are often performed earlier than recommended intervals based on guidelines. These procedures expose patients to procedural risks, inconvenience with scheduling and unnecessary preps, and add to healthcare costs, as well as increase caseload for endoscopy centers that often have limited capacity. In the context of updated surveillance guidelines that lengthen follow-up intervals for some adenomas, we sought to assess the proportion of 5-year surveillance colonoscopies scheduled without appropriate indication. Methods: We conducted a retrospective cohort study of all outpatient endoscopic procedures scheduled in a tertiary, academic medical center over a 4-week period (4/25/22-5/20/22). We screened for cases that had an active Electronic Health Record (EHR) flag for 5-year screening colonoscopy and were classified by the ordering provider as having a screening, non-diagnostic indication, and then confirmed the EHR flag and indication with chart review. Two physicians conducted chart review of last colonoscopy and ordering provider documentation to evaluate indication and appropriateness for 5-year screening based on US Multi-Society Task Force February 2020 guidelines. Results: The 4-week period included 2,222 total procedures scheduled, of which 149 were colonoscopies scheduled for 5-year surveillance. Of these, 57% (85/149) were inappropriate based on current guidelines, which accounts for 4% (85/2,222) of total cases. 74% (63/85) of inappropriate cases were due to not meeting polyp-based guidelines, where 65% (55/85) was due to the 2020 change in guidelines. 24% (20/85) were based on inappropriately applied family history. (Figure) Conclusion: A majority of cases scheduled for 5-year surveillance were not indicated, where most were inappropriate based on updated polyp-based guidelines. Interventions targeting these cases and assessing overall appropriateness of cases may reduce patient harm and increase the capacity for necessary procedures.Figure 1.: (a) Appropriateness of Scheduled 5-Year Surveillance Colonoscopies (b) Reasons for Inappropriate Colonoscopy Scheduling

S334 Geographic Diversity of Data Behind Surveillance Colonoscopy Guidelines in the United States

Introduction: The selection of an appropriate surveillance interval after colonoscopy for colorectal cancer screening can minimize unnecessary procedures while preventing the development of interval neoplasia. Both the 2020 US Multi-Society Task Force guidelines and earlier iterations incorporate international data, but not all areas of the world may be represented equally. We examined the studies cited in the US surveillance colonoscopy guidelines to determine the representation of different geographic regions. Methods: We examined studies which were incorporated into the US surveillance colonoscopy guidelines between 1997 and 2020 for the following categories: normal exam, exam with adenomas, exam with sessile serrated polyps (SSPs), and exam with hyperplastic polyps (HPs). For each category, we calculated the number of studies and total number of patients that came from each region of the world. We also examined trends in the number of studies from different region over time for each of the four categories. Results: There were 18 studies totaling 9,052,886 patients pertaining to surveillance after a normal exam, 54 studies totaling 226,730 patients for adenomas, 7 studies totaling 20,993 patients for SSPs, and 5 studies totaling 22,645 patients for HPs. Thirty-eight studies (49%) were from North America, 24 (31%) from Western Europe, 11 (14%) from East Asia, and 4 (5%) were from other regions (2 from Israel, 1 from Australia, and 1 from Argentina). The greatest number of studies in all categories came from North America, though studies from other regions increased over time (Figure). North America contributed the largest number of patients to studies on normal exams (50%) and HPs (100%), whereas Western Europe contributed the greatest number (61%) for adenomas and East Asia contributed the greatest number (51%) for SSPs. Conclusion: The number of patients included in studies on surveillance after adenomas, SSPs, and HPs were an order of magnitude less than that of a normal exam which could limit the strength of recommendations for these polyp types. Furthermore, nearly all data were drawn from patients in North America, Western Europe, or East Asia with little representation from populations in other regions. Given the multicultural nature of the US population, incorporating research from other regions of the world could improve the generalizability of current surveillance colonoscopy guidelines.Figure 1.: Distribution of studies by region on surveillance interval after colonoscopy with (A) no polyps, (B) adenomas, (C) sessile serrated polyps, and (D) hyperplastic polyps

S290 Is Fecal Immunochemical Test (FIT) the Answer to Increasing Colorectal Cancer Screening (CRC) Uptake in the Filipino Community? Results From a Conjoint Analysis Survey

Introduction: Asian Americans are the fastest growing major racial/ethnic group in the US, with Filipinos comprising the 3rd largest group. While >80% of Filipinos are proficient in English, and have insurance rates, education levels, and incomes that exceed the general US population, they have lower CRC screening rates and worse CRC outcomes vs. non-Hispanic Whites. To begin to address this disparity, we used conjoint analysis to understand Filipinos’ preferences for the different CRC screening test options. Methods: To quantify Filipinos’ preferences for CRC screening tests, we conducted a choice-based conjoint analysis survey for individuals ≥40yo at average risk for CRC who had not undergone prior screening. From 4/29-11/7/21, we recruited Filipinos at an academic medical center and through a national survey research firm (Cint). Using the conjoint data, we performed simulations to determine each individual’s preferred screening test; for this analysis, we focused on the proportion of people who preferred annual FIT or colonoscopy every 10 years as both are tier 1 tests according to the US Multi-Society Task Force (MSTF) on CRC. We then performed logistic regression to explore whether demographics predicted decision making on FIT vs colonoscopy; variables with p< .20 from bivariate analyses were included as covariates in the regression model. Results: Overall, 105 participants completed the survey; most respondents were female (74.3%) and aged 40-49y (84.8%). Moreover, 64.8% of participants stated they planned to get screened for CRC and they reported high self-perceived benefits of CRC screening (median 4.4, IQR 3.8-4.8; 1-5 scale, higher=more beneficial). When performing simulations using the conjoint data for the US MSTF tier 1 tests, we found that 66.7% of respondents preferred an annual FIT while 33.3% preferred a colonoscopy every 10 years (Figure). In a regression analysis that accounted for sex, marital status, household income, employment status, and geographic region, no variables were significantly associated with individual's preference for FIT over colonoscopy (Table). Conclusion: We found that 2 in 3 Filipinos prefer annual FIT over colonoscopy for their CRC screening and that demographics poorly predict individual decision making. To improve CRC screening uptake in the Filipino community, our data suggest that community-based interventions should either focus primarily on FIT or employ a choice-based approach (ie, FIT or colonoscopy).Figure 1.: Data from simulations using conjoint analysis data assessing the proportion of respondents who would prefer each MSTF tier 1-recommended test (N=105) Table 1. - Regression analysis on preferring FIT every year over colonoscopy every 10 years for CRC screening; screening test preferences were determined through simulations from conjoint analysis-derived data (N=105) Variable Prefers FIT every year for CRC screening n (% of row) aOR [95% CI] Sex: Male 21 (77.8%) Reference Female 49 (62.8%) 0.61 (0.20, 1.86) Marital status: Married or living with a partner 53 (62.4%) Reference Not married 17 (85.0%) 2.65 (0.61, 11.44) Total household income: ≤$100,000 34 (79.1%) reference >$100,000 31 (62.0%) 0.72 (0.24, 2.20) Prefer not to say 5 (41.7%) 0.23 (0.05, 1.12) Employment status: Unemployed, on disability, on leave of absence from work, retired, or a homemaker 19 (82.6%) reference Employed or student 51 (62.2%) 0.36 (0.10, 1.31) US region: Northeast/South/ Midwest 15 (83.3%) reference West 55 (63.2%) 0.70 (0.15, 3.21) Has non-first degree relative or friend diagnosed with CRC 11 (44.0%) 0.42 (0.15, 1.16)