Faculty Bibliography

INTRODUCTION/BACKGROUND:Annual stool testing with fecal occult blood testing (FOBT) or fecal immunochemical test (FIT) is commonly used for colorectal cancer screening but the incremental benefit of adherence to multiple rounds of stools tests for long-term reduction in CRC incidence has not been studied. Our aims were to study the incremental effect of repeat annual FOBT on 20-year CRC incidence in an average-risk screen-eligible population. METHODS:We used data from the Minnesota Colon Cancer Control Clinical trial, which enrolled 45,661 individuals to undergo annual biennial or no screening. We studied the difference in 20-year CRC incidence between those who do and do not complete each round of screening, from round 1 to round 4, in the annual arm. RESULTS:Overall, 13,130 participants from the annual arm completed the first round of screening, and 12,638 were eligible for round 2, 10,863 were eligible for round 3 and 9206 were eligible for round 4. The adjusted risk of CRC at 20 years for those who completed round 2 was 1.60 (95% CI: 0.34-2.87) percentage points lower than that of those who did not. The adjusted 20-year incidence of CRC in those who completed rounds 3 and 4 was 0.51 (95% CI: -0.73, 1.75) and 0.08 (95% CI: -1.19, 1.35) percentage point lower than those who did not complete rounds 3 and 4, respectively, and was not statistically significant. CONCLUSIONS:Our study underscores the importance of adherence to more than 1 round of screening and provides information for providers and patients about the benefits they may accrue from at least 2 rounds of adherence. We also found that the overall value of repeat screening after 2 negative rounds is important but provides marginal gain. The implications are that perfect adherence over multiple rounds may not be necessary to accrue the benefits of a reduction in CRC incidence and mortality.

BACKGROUND:Despite the availability of multiple screening options, rates of colorectal cancer (CRC) screening remain suboptimal. With recent approval of a blood test for CRC screening, there is an urgent need to understand screening preferences of populations with low screening rates. METHODS:Between October 2023 and June 2024, we conducted a survey on preferences for CRC screening modalities of stool test, blood test and colonoscopy among adults aged 45-75 at ambulatory primary care clinics across multiple community health centers and federally qualified healthcare centers across the city as well as in community settings regardless of prior screening. RESULTS:A total of 1,014 individuals completed the survey. Respondents were 12.8% Black/African American, 51.6% White, 23.4% Hispanic, 15.8% South Asian, and 4.2% Asian. Overall, the highest test preference was for screening colonoscopy (45.5%) followed by blood test (29.9%). Colonoscopy was preferred by individuals under age 70 (47.5%), while stool-based (20.2%) and blood-based (31.9%) tests were the most preferred among above 70 years (p = 0.0429. Whites (54.6%), Blacks (44.6%), and Hispanics (35.9%, p < 0.001) preferred colonoscopy, while Asians (37.2%) and South Asians (24.4%) favored blood tests. Factors associated with preference for a colonoscopy over other screening tests were younger age: respondents aged below 70 years were more likely to prefer colonoscopy, compared to respondents aged above 70 years (OR 1.72, 95% CI [1.20-2.47], p = 0.003); Nonsmoker compared to former/current smokers (OR 2.04, 95% CI [1.10-3.94], p = 0.028); Having undergone a prior colonoscopy (OR 6.83, 95% CI [4.52-10.6], p = < 0.001) or not having a prior stool test (OR 1.56, 95% CI [1.52-2.11], p = < 0.001). Factors associated with preference for a blood test over other screening tests were education level: respondents without any college experience were more likely to prefer blood test compared to respondents with college experience (OR 1.46, 95% CI 1.02-2.07, p = 0.038); Nonsmoker compared to former/current smokers (OR 1.73, 95% CI [1.00-2.99], p = 0.048); Never undergone a prior colonoscopy (OR 1.76, 95% CI [1.23-2.51], p = 0.002). Factors associated with preference for a stool test over other screening tests were: age over 80 years compared to respondents aged below 80 (OR 3.34, 95% CI 1.67-6.55, p < 0.001); respondents with college experience were more likely to prefer blood test compared to respondents without college experience (OR 1.62, 95% CI 1.02-2.66, p = 0.048). CONCLUSION/CONCLUSIONS:Colonoscopy was the preferred test option, followed by blood test. Preferences for screening test varied by age, race, ethnicity, education and prior screening. The study underscores importance of patient preference in deciding which tests to offer based on the patient characteristics. Nonsmokers, those without any college education and those without prior screening preferred blood test for screening.

BACKGROUND:Following polypectomy, patients with adenomas containing high-grade dysplasia (HGD) are recommended to undergo surveillance at three years due to increased risk of metachronous neoplasia. However, while proximal colon cancers are associated with worse prognosis compared to distal tumors, limited data exist regarding how laterality of an initial HGD adenoma influences the subsequent risk of colon cancer. This study aimed to analyze the role of laterality of HGD adenoma on the incidence of metachronous colon cancer. METHODS:The SEER-Medicare-linked database was queried for adults aged ≥65 years who underwent endoscopic polypectomy for HGD adenoma in the proximal or distal colon, defined relative to the splenic flexure (2006-2019). Cox regression assessed the effect of adenoma location on metachronous malignancy. Survival was assessed with a Kaplan-Meier model. RESULTS:In a cohort of 523 patients, 41% had proximal HGD adenoma. Ten-year cumulative incidence of post-polypectomy colon cancer was 33% for proximal and 8% for distal adenomas (p<0.01). Median time to diagnosis of colon cancer was 2.8 years for proximal vs. 4.1 years for distal adenomas. Proximal HGD location was significantly associated with increased incidence of metachronous cancer (HR 4.19; 95% CI 1.90-9.26) after adjusting for age and sex. Patients with proximal HGD had worse ten-year overall survival compared to distal adenoma (49% vs. 57%). CONCLUSIONS:Proximal location of HGD adenoma was associated with a four-fold increased incidence of and shorter interval to metachronous colon cancer diagnosis. Location of HGD adenoma may be taken into consideration when determining clinical management and surveillance.

Fecal immunochemical testing (FIT) screens for colorectal cancer (CRC) through detection of hemoglobin. Specimens without a collection date are a common source of test cancellation. We implemented a quality improvement intervention to improve collection date documentation and screening completion using a pre-post design. Within a large US Veterans Affairs (VA) CRC screening trial, we modified the FIT return envelope instructions, including a field for collection date documentation on the envelope. Preintervention 6654/7083 FIT kits (93.9%) were received with a collection date compared to 3069/3105 (98.8%) postintervention (p < .00001). Preintervention, 35.2% of kits without a date were received within 15 days of original outbound mailing of the kit from VA, thereby allowing testing in 95.4% of all kits received. Postintervention, 44.4% of undated kits were received within 15 days of mailing from the VA, allowing for testing of 98.8% of all kits (p < .00001 compared to preintervention). The intervention was associated with an absolute 3.5% (95% CI: 2.8%-4.1%) increase in testable kits, thereby reducing the proportion of individuals requiring retesting from 4.6% to 1.2%. This no-cost, targeted intervention was associated with a significantly increased proportion of individuals successfully completing screening. Programs using FIT should consider implementation of this no-cost intervention to enhance program effectiveness.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) remains one of the leading causes of cancer-related morbidity and mortality in the United States. Despite the wide availability of effective screening tools, adherence to screening modalities and recommendations remains a significant challenge, influenced by various sociodemographic factors. This study examines the disparities and factors related to adherence to CRC screening methods. METHODS:Participants aged 45 to 75 years were selected from the 2022-2023 BRFSS dataset. The key variables extracted included CRC screening modalities and test frequencies (colonoscopy, sigmoidoscopy, stool testing, and virtual colonoscopy), as well as sociodemographic characteristics. Multivariate logistic regression was performed to explore associations between social factors and up-to-date adherence to specific screening tests. RESULTS:A total of 239,512,188 (Weighted frequency) adults were included in this study, with the majority identifying as White (63.90%), female (51.92%), having access to a primary care provider (PCP; 90.64%), married (61.36%), reporting a yearly income of $50,000 or greater (69.17%), and residing in urban areas (93.11%). The most reportedly used screening options were colonoscopy (27.34%) and stool-based tests (8.67%). Up-to-date adherence to colonoscopy was more likely among adults who are Black non-Hispanic (aOR = 1.86, 95% CI [1.57-2.19], p < .0001), had access to PCPs (aOR = 2.13, 95% CI [1.80-2.52], p < .0001), and urban residents (aOR = 1.18, 95%CI [1.04-1.34], p = 0.0105) among cohorts with colonoscopy. Up-to-date adherence to stool test was more likely among Hispanic (aOR = 1.37, 95%CI [1.03-1.81], p = 0.0296), those with access to a PCP (aOR 1.63, 95%CI [1.21-2.21], p = 0.0014), individuals who were divorced (aOR = 1.15, 95%CI [1.00-1.32], p = 0.0431), and uneducated ( aOR = 1.58, 95%CI [1.15-2.16], p = 0.0046) among cohorts with stool test. CONCLUSION/CONCLUSIONS:Racial/ethnic background, socioeconomic status, and marital status were associated with whether individuals adhered to a particular screening modality among their cohorts with the same screening test. We recommend creating specific and culturally aware programs to overcome obstacles and targeted interventions among patients, which may help improve adherence rates.

INTRODUCTION/BACKGROUND:Colorectal cancer(CRC) is the third most commonly diagnosed malignancy with a rising global incidence. CRC shares many risk factors with other malignancies and may occur as a part of hereditary cancer syndromes. This retrospective cohort study aims to evaluate outcomes in patients with CRC and a history of prior malignancy to identify potential implications for personalized management. METHODS:The National Cancer Database was queried from 2004 to 2022 for patients diagnosed with CRC, who were stratified into two cohorts: those with and without malignancies prior to CRC diagnosis. Propensity score matching was performed to balance sociodemographic characteristics, and logistic regression was used to estimate odds ratios(ORs) for tumor and treatment characteristics. Subsequently, a Cox proportional hazards model was fit to assess the association of having prior malignancies and mortality. RESULTS:A total of 576,076 patients were included, with 288,038 in each cohort. Patients with prior malignancies had significantly lower odds of KRAS mutation(OR = 0.86, 95% CI:0.83-0.89, p < 0.001), abnormal CEA levels(OR = 0.95, 95% CI:0.94-0.96, p < 0.001), perineural invasion(OR = 0.86, 95% CI:0.84-0.88, p < 0.001), early-onset CRC(OR = 0.73, 95% CI:0.71-0.74, p < 0.001), advanced-stage CRC(OR = 0.77, 95% CI:0.76-0.77, p < 0.001), and tumor deposits(OR = 0.82, 95% CI:0.80-0.84, p < 0.001). These patients also had higher odds of receiving treatment(OR = 1.05, 95% CI:1.02-1.08, p < 0.001). However, they had higher odds of microsatellite instability(OR = 1.20, 95% CI:1.17-1.23, p < 0.001), treatment delays(OR = 1.42, 95% CI:1.40-1.43, p < 0.001), and postoperative readmissions(OR = 1.14, 95% CI:1.11-1.17, p < 0.001). Patients with a history of prior malignancies were associated with higher overall mortality(aHR = 1.19, 95% CI:1.10-1.27, p < 0.001) as well as stage-specific mortality, except for stage 1 CRC. CONCLUSION/CONCLUSIONS:These findings indicate that patients with prior malignancies may require greater preoperative optimization, closer post-discharge monitoring, and proactive efforts to avoid treatment delays.

INTRODUCTION/BACKGROUND:We investigated the impact of racial/ethnic disparities in therapy initiation on colorectal cancer (CRC) mortality using Surveillance, Epidemiology, and End Results Program (SEER) database. METHODS:Adults aged 18-84 years with CRC were identified. Cox models for 60-month all-cause and cancer-specific mortality were adjusted for demographics, stage, tumor site, income, and rural-urban residence. RESULTS:Therapy initiation was slower for Hispanics (HR 0.85) and non-Hispanic Black (NHB) patients (HR 0.80) compared with non-Hispanic Whites (p < 0.001). Each additional month of delay was associated with a 3% increase in cancer mortality (p < 0.001). Findings were consistent across diagnosis eras, with no significant race-by-era interaction, and adjustment for socioeconomic and geographic factors resulted in minimal attenuation of racial disparities. CONCLUSION/CONCLUSIONS:Treatment delays independently contribute to all-cause and cancer-specific mortality, disproportionately affecting NHB and lower-SES patients.