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Zhao MY, Lei YY, Aaronson MRM, De Silva SR, Badiee J, May FP. Colorectal Cancer Screening Rates at Federally Qualified Health Centers From 2014 to 2022: Incomplete Recovery From COVID-19 and Worsening Disparities. Am J Gastroenterol 2024; 119:1580-1589. [PMID: 38529856 DOI: 10.14309/ajg.0000000000002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/15/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Federally Qualified Health Centers (FQHC) provide preventive health services such as colorectal cancer (CRC) screening to low-income and underinsured individuals. Overall CRC screening participation in the United States declined during the COVID-19 pandemic and recovered by 2021; however, trends in underresourced settings are unknown. METHODS Using Uniform Data System data from 2014 to 2022, we assessed trends in FQHC CRC screening rates nationally, in California, and in Los Angeles County and determined clinic-level factors associated with recent screening rate changes. For each FQHC, we calculated the screening rate change from 2019 to 2020, 2020 to 2021, and 2020 to 2022. We used mixed-effects linear regression to determine clinic-level characteristics associated with each screening rate change. RESULTS Across all FQHC (n = 1,281), 7,016,181 patients were eligible for CRC screening in 2022. Across the United States and in California, median screening rates increased from 2014 to 2019, severely declined in 2020, and failed to return to prepandemic levels by 2022. Both nationally and in California, CRC screening declined most dramatically from 2019 to 2020 in FQHC serving majority Hispanic/Latino patients or a high proportion of patients experiencing homelessness. From 2020 to 2022, screening rates did not recover completely in US FQHC, with disproportionate recovery among FQHC serving majority non-Hispanic Black patients. DISCUSSION CRC screening rates at FQHC did not return to prepandemic levels by 2022, and recovery varied by FQHC patient characteristics. Tailored interventions addressing low and decreasing CRC screening rates in FQHC are urgently needed to mitigate worsening CRC disparities.
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Affiliation(s)
- Matthew Y Zhao
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Yvonne Y Lei
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan R M Aaronson
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Sadie R De Silva
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jayraan Badiee
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
- UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, USA
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Aleissa M, Drelichman ER, Mittal VK, Bhullar JS. Barriers in early detection of colorectal cancer and exploring potential solutions. World J Clin Oncol 2024; 15:811-817. [PMID: 39071472 PMCID: PMC11271734 DOI: 10.5306/wjco.v15.i7.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/21/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
This editorial discusses the literature review article by Tonini and Zanni, the paper was published in January 2024, and the authors provided very interesting conclusions regarding existing barriers to the early diagnosis of colon cancer. Many cancers do not have identifiable precursors, or there are currently no screening tests to find them. Therefore, these cancers do not have preventive screening options. Early detection is crucial for reducing mortality rates by identifying cancer at an earlier stage through screening, as opposed to no screening. Colorectal cancer develops from precancerous lesions, which can be detected early and potentially prevented and cured. Early detection leads to improved survival rates, decreased complications, and reduced healthcare expenses. This editorial provides a brief description of the biology of colon cancer, emphasizing the contrast in outcomes between early detection and late detection. We also describe screening programs around the globe and examine the barriers in each program. Finally, we explore potential future solutions to enhance inclusion in screening programs and improve patient compliance.
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Affiliation(s)
- Maryam Aleissa
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
- College of Medicine, Princess Norah University Hospital, Riyadh 11564, Saudi Arabia
| | - Ernesto Raul Drelichman
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
| | - Vijay K Mittal
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
| | - Jasneet Singh Bhullar
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
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Huang Q, Peng W, Han J, Mao B. Characterizing the Perceived Need for CRC Screening among the Elderly Living in Rural Areas in the Pacific Northwest US: Roles of Miscommunication, Experience of Discrimination, and Dependence. Am J Health Promot 2024:8901171241257051. [PMID: 38780489 DOI: 10.1177/08901171241257051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
PURPOSE Increasing the perceived need for CRC screening can facilitate undertaking CRC screening. This study aims to identify factors associated with the need for CRC screening in rural populations. DESIGN A cross-sectional online survey. SETTING The survey was conducted in June - September 2022 in the rural areas of Alaska, Idaho, Oregon, and Washington, US. SUBJECTS The subjects of this study were 250 adults (completion rate: 65%) aged 45-75 residing in rural Alaska, Idaho, Oregon, and Washington. MEASURES Perceived need for CRC screening, internet usage for health purposes, demographics, and intrapersonal, interpersonal, community, and environmental characteristics. RESULTS Perceived need for CRC screening were negatively associated with patient-provider miscommunication (β = -.23, P < .001) and perceived discrimination (β = -.21, P < .001), cancer fatalism (β = -.16, P < .05), individualism (β = -.15, P < .05), and dependence on community (β = -.11, P < .05), but positively with compliance with social norms (β = .16, P < .05), trust in health care providers (β = .16, P < .05), knowledge about colorectal cancer (β = .12, P < .05). CONCLUSIONS Our study showed potential individual and situational characteristics that might help increase colorectal cancer screening. Future efforts might consider addressing discrimination in health care settings, improving patient-provider communication, and tailoring messaging to reflect the rural culture.
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Affiliation(s)
- Qian Huang
- Department of Communication, University of North Dakota, Grand Forks, ND, USA
| | - Wei Peng
- Washington State University, Edward R. Murrow College of Communication, Pullman, WA, USA
| | - Jihae Han
- Washington State University, Edward R. Murrow College of Communication, Pullman, WA, USA
| | - Bingjing Mao
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Glaser KM, Crabtree-Ide CR, McNulty AD, Attwood KM, Flores TF, Krolikowski AM, Robillard KT, Reid ME. Improving Guideline-Recommended Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC): Implementing a Patient Navigation and Practice Facilitation Intervention to Promote Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:126. [PMID: 38397617 PMCID: PMC10887785 DOI: 10.3390/ijerph21020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective in the prevention and early detection of cancer. Implementing evidence-based screening guidelines remains a challenge, especially in Federally Qualified Health Centers (FQHCs), where current rates (43%) are lower than national goals (80%), and even lower in populations with limited English proficiency (LEP) who experience increased barriers to care related to systemic inequities. METHODS This quality improvement (QI) initiative began in 2016, focused on utilizing patient navigation and practice facilitation to addressing systemic inequities and barriers to care to increase CRC screening rates at an urban FQHC, with two clinical locations (the intervention and control sites) serving a diverse population through culturally tailored education and navigation. RESULTS Between August 2016 and December 2018, CRC screening rates increased significantly from 31% to 59% at the intervention site (p < 0.001), with the most notable change in patients with LEP. Since 2018 through December 2022, navigation and practice facilitation expanded to all clinics, and the overall CRC screening rates continued to increase from 43% to 50%, demonstrating the effectiveness of patient navigation to address systemic inequities. CONCLUSIONS This multilevel intervention addressed structural inequities and barriers to care by implementing evidence-based guidelines into practice, and combining patient navigation and practice facilitation to successfully increase the CRC screening rates at this FQHC.
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Affiliation(s)
- Kathryn M. Glaser
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Christina R. Crabtree-Ide
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
| | - Alyssa D. McNulty
- Department of Cancer Prevention and Populations Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Kristopher M. Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Tessa F. Flores
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
| | | | - Kevin T. Robillard
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Mary E. Reid
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.R.C.-I.); (T.F.F.); (M.E.R.)
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Adegboyega A, Adeyimika D, Omoadoni O, Mark D. HPV vaccination and cervical cancer screening promotion among Black individuals: social ecological perspectives from key informants interviews. ETHNICITY & HEALTH 2023; 28:1026-1040. [PMID: 36973897 PMCID: PMC10522792 DOI: 10.1080/13557858.2023.2193360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/10/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. DESIGN Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. RESULTS Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. CONCLUSIONS SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population.
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Affiliation(s)
| | | | | | - Dignan Mark
- College of Medicine, Prevention Research Center, University of Kentucky, Lexington, KY, USA
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Wang K, Ma W, Hu Y, Knudsen MD, Nguyen LH, Wu K, Ng K, Wang M, Ogino S, Sun Q, Giovannucci EL, Chan AT, Song M. Endoscopic Screening and Risk of Colorectal Cancer according to Type 2 Diabetes Status. Cancer Prev Res (Phila) 2022; 15:847-856. [PMID: 36049216 PMCID: PMC9722520 DOI: 10.1158/1940-6207.capr-22-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
Current recommendations for colorectal cancer screening have not accounted for type 2 diabetes (T2D) status. It remains unknown whether the colorectal cancer-preventive benefit of endoscopic screening and the recommended age for screening initiation differ by T2D. Among 166,307 women (Nurses' Health Study I and II, 1988-2017) and 42,875 men (Health Professionals Follow-up Study, 1988-2016), endoscopic screening and T2D diagnosis were biennially updated. We calculated endoscopic screening-associated hazard ratios (HR) and absolute risk reductions (ARR) for colorectal cancer incidence and mortality according to T2D, and age-specific colorectal cancer incidence according to T2D. During a median of 26 years of follow-up, we documented 3,457 colorectal cancer cases and 1,129 colorectal cancer deaths. Endoscopic screening was associated with a similar HR of colorectal cancer incidence in the T2D and non-T2D groups (P-multiplicative interaction = 0.57). In contrast, the endoscopic screening-associated ARR for colorectal cancer incidence was higher in the T2D group (2.36%; 95% CI, 1.55%-3.13%) than in the non-T2D group (1.73%; 95% CI, 1.29%-2.16%; P-additive interaction = 0.01). Individuals without T2D attained a 10-year cumulative risk of 0.35% at the benchmark age of 45 years, whereas those with T2D reached this threshold risk level at the age of 36 years. Similar results were observed for colorectal cancer mortality. In conclusion, the absolute benefit of endoscopic screening for colorectal cancer prevention may be substantially higher for individuals with T2D compared with those without T2D. Although T2D is comparatively rare prior to the fifth decade of life, the rising incidence of young-onset T2D and heightened colorectal cancer risk associated with T2D support the consideration of earlier endoscopic screening in individuals with T2D. PREVENTION RELEVANCE The endoscopic screening-associated ARRs for colorectal cancer incidence and mortality were higher for individuals with T2D than those without T2D. Endoscopic screening confers a greater benefit for colorectal cancer prevention among T2D individuals, who may also benefit from an earlier screening than the current recommendation.
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Affiliation(s)
- Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yang Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Markus Dines Knudsen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Section of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway,Norwegian PSC Research Center, Inflammatory Diseases and Transplantation, Division of Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Long H. Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kana Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Cancer Immunology Program, Dana-Farber / Harvard Cancer Center, Boston, MA, USA,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Qi Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Joslin Diabetes Center, Boston, MA, USA
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Broad Institute of MIT and Harvard, Cambridge, MA, USA,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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7
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Santiago-Rodríguez EJ, Rivadeneira NA, Torres JM, Sarkar U, Hiatt RA. Socioeconomic status and colorectal cancer screening behaviors in a vulnerable multiethnic population. ETHNICITY & HEALTH 2022; 27:980-996. [PMID: 33121258 PMCID: PMC8081754 DOI: 10.1080/13557858.2020.1838454] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Despite some progress in recent years, colorectal cancer (CRC) screening adherence in the United States is still suboptimal, particularly among disadvantaged groups. In this study, we assessed the association between socioeconomic status (SES) and self-reported screening non-adherence (SNA) in a sample of racial/ethnic minorities living in San Francisco, California. DESIGN/METHODS A total of 376 participants of the San Francisco version of the Health Information National Trends Survey (SF-HINTS) with ages 50-75 years were included in this cross-sectional study. SNA was defined as not reporting blood stool test within the past year and not reporting sigmoidoscopy/colonoscopy within the past 10 years. Poisson regression models with robust variance estimators were used to evaluate the relation of SES with SNA, adjusting for measured confounders. Results are reported as prevalence ratios (PR) and 95% confidence intervals (95% CI). RESULTS Overall SNA was 40%. In multivariable models including all respondents, retired participants had significantly lower SNA prevalence than employed participants (PR = 0.46, 95% CI = 0.26 0.83). In stratified analyses by race/ethnicity, Black respondents with less than high school (PR = 1.93, 95% CI = 1.09, 3.43) and those with high school or equivalent (PR = 1.88, 95% CI = 1.16, 3.04) had significantly higher SNA prevalence than those with at least some college. Among non-Hispanic Asian/Pacific Islanders, those disabled had significantly higher prevalence of SNA as compared to employed people (PR = 4.26, 95% CI = 2.11, 8.60). None of the SES indicators were significantly associated to SNA among Hispanics. CONCLUSIONS Participants with lower SES characteristics were less likely to adhere to CRC screening guidelines and being retired was a predictor of compliance. There was evidence of heterogeneity in associations between SES and CRC screening by race/ethnicity. Life circumstances of retired people could provide insights for designing interventions aimed to improve CRC screening uptake in these priority groups. Future efforts should consider mechanisms underlying differences by race/ethnicity.
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Affiliation(s)
| | - Natalie A. Rivadeneira
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Robert A. Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- UCSF Helen Diller Family Comprehensive Cancer Center
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Huguet N, Hodes T, Holderness H, Bailey SR, DeVoe JE, Marino M. Community Health Centers' Performance in Cancer Screening and Prevention. Am J Prev Med 2022; 62:e97-e106. [PMID: 34663549 PMCID: PMC8748316 DOI: 10.1016/j.amepre.2021.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Little is known about what clinic-level factors differentiate community health centers that achieve high performance on cancer-preventive care metrics. This study aims to describe the longitudinal trends in the delivery of 3 cancer-preventive care metrics (cervical and colorectal cancer screenings and tobacco-cessation intervention) and define and compare community health centers with high cancer-preventive care performance with those with low cancer-preventive care performance. METHODS This observational study used 2012-2019 community health center data (N=933) from the Uniform Data System. High/low performance was based on Healthy People 2020 targets and sample distribution. For each cancer-preventive care metric, the percentage of community health centers that met high (≥70.5% at cervical or colorectal cancer screening or >80% tobacco-cessation intervention) and low thresholds at 1, 2, and all the 3 screenings was estimated. Multivariable generalized estimating equations logistic regression modeling was used to assess the community health center‒level factors associated with screening performance. RESULTS The community health centers' performance for tobacco-cessation intervention remained at ≥80%, with a small increase over time. Performance for cervical cancer screening remained unchanged with about 50% of patients screened. Colorectal cancer screening performance increased from around 30% in 2012 to 44% in 2019. Very few community health centers reached high performance (3%) in all the 3 indicators, and 13% of community health centers were high in any 2 of the outcomes in 2019. Higher patient volume, a greater proportion of Hispanic patients, fewer uninsured patients, and community health centers located in the Northeast region were associated with high performance in 2019. CONCLUSIONS Very few community health centers meet all Healthy People 2020 goals in cancer screenings and may struggle to achieve the 2030 goals. Very few indicators differentiated high performers from low performers.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tahlia Hodes
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Heather Holderness
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; Biostatistics Group, School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
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9
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Wang K, Ma W, Wu K, Ogino S, Giovannucci EL, Chan AT, Song M. Long-Term Colorectal Cancer Incidence and Mortality After Colonoscopy Screening According to Individuals' Risk Profiles. J Natl Cancer Inst 2021; 113:1177-1185. [PMID: 33734405 PMCID: PMC8418388 DOI: 10.1093/jnci/djab041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/28/2020] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It remains unknown whether the benefit of colonoscopy screening against colorectal cancer (CRC) and the optimal age to start screening differ by CRC risk profile. METHODS Among 75 873 women and 42 875 men, we defined a CRC risk score (0-8) based on family history, aspirin, height, body mass index, smoking, physical activity, alcohol, and diet. We calculated colonoscopy screening-associated hazard ratios and absolute risk reductions (ARRs) for CRC incidence and mortality and age-specific CRC cumulative incidence according to risk score. All statistical tests were 2-sided. RESULTS During a median of 26 years of follow-up, we documented 2407 CRC cases and 874 CRC deaths. Although the screening-associated hazard ratio did not vary by risk score, the ARRs in multivariable-adjusted 10-year CRC incidence more than doubled for individuals with scores 6-8 (ARR = 0.34%, 95% confidence interval [CI] = 0.26% to 0.42%) compared with 0-2 (ARR = 0.15%, 95% CI = 0.12% to 0.18%, Ptrend < .001). Similar results were found for CRC mortality (ARR = 0.22%, 95% CI = 0.21% to 0.24% vs 0.08%, 95% CI = 0.07% to 0.08%, Ptrend < .001). The ARR in mortality of distal colon and rectal cancers was fourfold higher for scores 6-8 than 0-2 (distal colon cancer: ARR = 0.08%, 95% CI = 0.07% to 0.08% vs 0.02%, 95% CI = 0.02% to 0.02%, Ptrend < .001; rectal cancer: ARR = 0.08%, 95% CI = 0.08% to 0.09% vs 0.02%, 95% CI = 0.02% to 0.03%, Ptrend < .001). When using age 45 years as the benchmark to start screening, individuals with risk scores of 0-2, 3, 4, 5, and 6-8 attained the threshold CRC risk level (10-year cumulative risk of 0.47%) at age 51 years, 48 years, 45 years, 42 years, and 38 years, respectively. CONCLUSIONS The absolute benefit of colonoscopy screening is more than twice higher for individuals with the highest than lowest CRC risk profile. Individuals with a high- and low-risk profile may start screening up to 6-7 years earlier and later, respectively, than the recommended age of 45 years.
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Affiliation(s)
- Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
| | - Kana Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard
Medical School, Boston, MA, USA
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology,
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,
USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of
Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital
and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
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10
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Sazali MF, Rahim SSSA, Hayati F, Mohd Daud MN, Avoi R, Omar A, Atil A, Abd Rahim MA, Madrim MF, Mokti K, Ramdzan AR, Sidek Ahmad ZN, Zakaria AD, Che Ani MF, Ibrahim AF, Azhar ZI, Jeffree MS, Hassan MR. Colorectal cancer and potential predictors of never screened for faecal occult blood test: a narrative review. J Public Health Res 2021; 11. [PMID: 34351098 PMCID: PMC8859728 DOI: 10.4081/jphr.2021.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Colorectal cancer (CRC) is a major public health threat. Therefore, CRC screening uptake has been a focus with the established precancerous lesion and the strong association of early detection with staging and survival of the disease. However, CRC screening is relatively low in many countries. This article briefly discussed the current situation of CRC, recommendations, and current uptake of CRC screening in various countries. Besides that, this article also highlights the potential factors that help to predict the CRC screening uptake worldwide. Identification of those factors could guide policymakers to develop an effective strategy to improve the CRC screening uptake and ultimately improve the health outcome of the population. Significance for public health This study highlights the public health challenge in early screening for colorectal cancer (CRC). The prevalence of never screened for faecal occult blood test is relatively high. This review dissects the issue and further discuss on the predictors, which could guide policymakers in developing strategy to improve CRC screening uptake.
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Affiliation(s)
- Mohd Fazeli Sazali
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Syed Sharizman Syed Abdul Rahim
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu.
| | - Mohd Nazri Mohd Daud
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Richard Avoi
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Azizan Omar
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Azman Atil
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Muhammad Aklil Abd Rahim
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Mohd Faizal Madrim
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Khalid Mokti
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Abdul Rahman Ramdzan
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Zulkhairul Naim Sidek Ahmad
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Andee Dzulkarnaen Zakaria
- Department of General Surgery, Hospital Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan.
| | - Mohd Firdaus Che Ani
- Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor.
| | - Aini Fahriza Ibrahim
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak.
| | - Zahir Izuan Azhar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor.
| | - Mohammad Saffree Jeffree
- Community and Family Medicine Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu, Sabah.
| | - Mohd Rohaizat Hassan
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Cheras, Kuala Lumpur.
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11
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Saad F, Ayyash M, Ayyash M, Elhage N, Ali I, Makki M, Hamade H, Blackwood RA. Assessing Knowledge, Physician Interactions and Patient-Reported Barriers to Colorectal Cancer Screening Among Arab Americans in Dearborn, Michigan. J Community Health 2021; 45:900-909. [PMID: 32189212 DOI: 10.1007/s10900-020-00807-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer related deaths among men and women in the United States (Haggar and Boushey in Clin Colon Rectal Surg 22:191-197, 2009). Screening tests have shown to be successful at early detection of precancerous polyps. Between 2000 and 2010, there was a 72% growth in the population that identifies having an Arabic-speaking ancestry (Arab American Institute in https://www.aaiusa.org/demographics , 2011). Despite this, little research has been conducted to assess this unique community's knowledge regarding CRC. Given that low screening rates can be attributed to lack of knowledge, this study was designed to address CRC knowledge and screening barriers in an Arab American community. Between February 2016 and June 2017, an anonymous survey was conducted in English or Arabic among 131 patients from cancer programs at the Arab Community Center for Economic and Social Services (ACCESS) in Dearborn, MI. Program participants were expected to have greater insight and awareness about cancer risk than the general population. Knowledge deficiencies surrounding CRC and the screening process were identified. 70% of participants did not know what a colon polyp is and over 89% were not aware of their individual risk for CRC. 45.8% have never had a CRC screening and leading barriers included screening costs, lack of health insurance, and lack of advice by physicians. The goal of this study was to serve as a tool to healthcare providers by identifying evident gaps in medical knowledge surrounding CRC. In order to help better serve and educate patients, healthcare providers and community organizations are encouraged to fight the stigma and help to reduce misunderstandings.
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Affiliation(s)
- Fatima Saad
- University of Michigan-Dearborn, Dearborn, MI, USA. .,Arab American Health Initiative, Dearborn, MI, USA. .,Office for Health Equity and Inclusion-Michigan Medicine, The University of Michigan, 1301 Catherine St, Medical Science Building 1, Ann Arbor, MI, 48109, USA.
| | - Mariam Ayyash
- Arab American Health Initiative, Dearborn, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology Henry Ford Health System, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marwa Ayyash
- Arab American Health Initiative, Dearborn, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nadine Elhage
- Arab American Health Initiative, Dearborn, MI, USA.,Michigan State University College of Osteopathic Medicine, Detroit, MI, USA
| | - Iman Ali
- Arab American Health Initiative, Dearborn, MI, USA.,University of Michigan, Ann Arbor, MI, USA
| | - Mona Makki
- Arab Community Center for Economic and Social Services, ACCESS, Dearborn, MI, USA
| | - Hiam Hamade
- Arab Community Center for Economic and Social Services, ACCESS, Dearborn, MI, USA
| | - R Alexander Blackwood
- Arab American Health Initiative, Dearborn, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Pediatrics and Communicable Diseases, Office of Health Equity and Inclusion, Arab American Health Initiative, Dearborn, MI, USA.,Office for Health Equity and Inclusion-Michigan Medicine, The University of Michigan, 1301 Catherine St, Medical Science Building 1, Ann Arbor, MI, 48109, USA
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12
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Davis MM, Schneider JL, Gunn R, Rivelli JS, Vaughn KA, Coronado GD. A qualitative study of patient preferences for prompts and reminders for a direct-mail fecal testing program. Transl Behav Med 2021; 11:540-548. [PMID: 32083287 PMCID: PMC7963281 DOI: 10.1093/tbm/ibaa010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Programs that directly mail fecal immunochemical tests (FIT) to patients can increase colorectal cancer (CRC) screening, especially in low-income and Latino populations. Few studies have explored patient reactions to prompts or reminders that accompany such programs. As part of the Participatory Research to Advance Colon Cancer Prevention pilot study, which tested prompts and reminders to a direct-mail FIT program in a large, urban health center, we conducted telephone interviews among English- and Spanish-speaking participants who were assigned to receive a series of text message prompts, automated phone call reminders, and/or live phone call reminders. We analyzed interviews using a qualitative content analysis approach. We interviewed 41 participants, including 25 responders (61%) and 16 nonresponders (39%) to the direct-mail program. Participants appreciated program ease and convenience. Few participants recalled receiving prompts or automated/live reminders; nevertheless, the vast majority (95%, n = 39) thought reminders were acceptable and helpful and suggested that 2-3 reminders delivered starting 1 week after the mailed FIT would optimally encourage completion. Prompts and reminders used with mailed-FIT programs are accepted by patients, and my help boost response rates.
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Affiliation(s)
- Melinda M Davis
- Oregon Rural Practice-Based Research Network, Department of Family Medicine, and School of Public Health, Oregon Health and Science University, Mail Code, Portland, OR, USA
| | | | - Rose Gunn
- Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer S Rivelli
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Katherine A Vaughn
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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13
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Wang K, Ma W, Wu K, Ogino S, Chan AT, Giovannucci EL, Song M. Healthy lifestyle, endoscopic screening, and colorectal cancer incidence and mortality in the United States: A nationwide cohort study. PLoS Med 2021; 18:e1003522. [PMID: 33524029 PMCID: PMC7886195 DOI: 10.1371/journal.pmed.1003522] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/16/2021] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Healthy lifestyle and screening represent 2 major approaches to colorectal cancer (CRC) prevention. It remains unknown whether the CRC-preventive benefit of healthy lifestyle differs by endoscopic screening status, and how the combination of healthy lifestyle with endoscopic screening can improve CRC prevention. METHODS AND FINDINGS We assessed lifestyle and endoscopic screening biennially among 75,873 women (Nurses' Health Study, 1988 to 2014) and 42,875 men (Health Professionals Follow-up Study, 1988 to 2014). We defined a healthy lifestyle score based on body mass index, smoking, physical activity, alcohol consumption, and diet. We calculated hazard ratios (HRs) and population-attributable risks (PARs) for CRC incidence and mortality in relation to healthy lifestyle score according to endoscopic screening. Participants' mean age (standard deviation) at baseline was 54 (8) years. During a median of 26 years (2,827,088 person-years) follow-up, we documented 2,836 incident CRC cases and 1,013 CRC deaths. We found a similar association between healthy lifestyle score and lower CRC incidence among individuals with and without endoscopic screening, with the multivariable HR per one-unit increment of 0.85 (95% CI, 0.80 to 0.90) and 0.85 (95% CI, 0.81 to 0.88), respectively (P-interaction = 0.99). The fraction of CRC cases that might be prevented (PAR) by endoscopic screening alone was 32% (95% CI, 31% to 33%) and increased to 61% (95% CI, 42% to 75%) when combined with healthy lifestyle (score = 5). The corresponding PAR (95% CI) increased from 15% (13% to 16%) to 51% (17% to 74%) for proximal colon cancer and from 47% (45% to 50%) to 75% (61% to 84%) for distal CRC. Results were similar for CRC mortality. A limitation of our study is that our study participants are all health professionals and predominantly whites, which may not be representative of the general population. CONCLUSIONS Our study suggests that healthy lifestyle is associated with lower CRC incidence and mortality independent of endoscopic screening. An integration of healthy lifestyle with endoscopic screening may substantially enhance prevention for CRC, particularly for proximal colon cancer, compared to endoscopic screening alone.
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Affiliation(s)
- Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Kana Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
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14
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Sazali MF, Syed Abdul Rahim SS, Avoi R, Hassan MR, Hayati F, Azhar ZI, Jeffree MS, Lukman KA, Tha NO, Sajali H, Atil A, Abd Rahim MA. Factors of Never Screened with Faecal Occult Blood Test in Public Primary Care Facilities. Asian Pac J Cancer Prev 2021; 22:163-169. [PMID: 33507695 PMCID: PMC8184202 DOI: 10.31557/apjcp.2021.22.1.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/23/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is still a major public health threat. In the effort to reduce CRC incidence and mortality, faecal occult blood test (FOBT) is currently the screening tools used for early detection of CRC. However, the uptake of FOBT screening is less than promising. This study aims to identify the prevalence and predictors of Never Screened with FOBT (NS-FOBT). METHODS A cross sectional study was conducted in five health clinics under Kota Kinabalu district, Sabah, Malaysia Borneo involving 162 attendees with age of 50 years old and above. A validated self-administered questionnaire was used to collect the data. Multiple logistic regression analysis was used to determine the predictors of NS-FOBT. RESULTS The prevalence of NS-FOBT was 85.8% (n=139). Important predictors of NS-FOBT were age (aOR: 0.922; 95% CI: 0.855, 0.995; p=0.035), Bumiputera ethnicity (vs Non Bumiputera; aOR: 4.285; 95% CI: 1.384, 13.263; p=0.012), knowledge score (aOR: 0.921; 95% CI: 0.856, 0.99; p=0.027), and attitude score (aOR: 0.801; 95% CI: 0.702, 0.913; p=0.001). CONCLUSION There is high prevalence of NS-FOBT. Age, ethnicity, knowledge, and attitude were important predictors of NS-FOBT. Strategies are needed to improve FOBT screening rate among the public. Socio-culturally tailored health promotion strategies as well as strengthening the communication, collaboration, and education to enhance the role of family physician is vital in improving the CRC prevention and care.
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Affiliation(s)
- Mohd Fazeli Sazali
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Syed Sharizman Syed Abdul Rahim
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Richard Avoi
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia.
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.
| | - Zahir Izuan Azhar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Malaysia.
| | - Mohammad Saffree Jeffree
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Khamisah Awang Lukman
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Naing Oo Tha
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Helmy Sajali
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Azman Atil
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
| | - Muhammad Aklil Abd Rahim
- Department of Community Health and Family Medicine, Faculty Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia.
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15
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Ni K, O'Connell K, Anand S, Yakoubovitch SC, Kwon SC, de Latour RA, Wallach AB, Sherman SE, Du M, Liang PS. Low Colorectal Cancer Screening Uptake and Persistent Disparities in an Underserved Urban Population. Cancer Prev Res (Phila) 2020; 13:395-402. [PMID: 32015094 DOI: 10.1158/1940-6207.capr-19-0440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/01/2020] [Accepted: 01/28/2020] [Indexed: 01/20/2023]
Abstract
Colorectal cancer screening has increased substantially in New York City in recent years. However, screening uptake measured by telephone surveys may not fully capture rates among underserved populations. We measured screening completion within 1 year of a primary care visit among previously unscreened patients in a large urban safety-net hospital and identified sociodemographic and health-related predictors of screening.We identified 21,256 patients ages 50 to 75 who were seen by primary care providers (PCP) in 2014, of whom 14,425 (67.9%) were not up-to-date with screening. Because PCPs facilitate the majority of screening, we compared patients who received screening within 1 year of an initial PCP visit to those who remained unscreened using multivariable logistic regression.Among patients not up-to-date with screening at study outset, 11.5% (1,658 patients) completed screening within 1 year of a PCP visit. Asian race, more PCP visits, and higher area-level income were associated with higher screening completion. Factors associated with remaining unscreened included morbid obesity, ever smoking, Elixhauser comorbidity index of 0, and having Medicaid/Medicare insurance. Age, sex, language, and travel time to the hospital were not associated with screening status. Overall, 39.9% of patients were up-to-date with screening by 2015.In an underserved urban population, colorectal cancer screening disparities remain, and overall screening uptake was low. Because more PCP visits were associated with modestly higher screening completion at 1 year, additional community-level education and outreach may be crucial to increase colorectal cancer screening in underserved populations.
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Affiliation(s)
- Katherine Ni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kelli O'Connell
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sanya Anand
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | | | - Simona C Kwon
- Department of Population Health, NYU Langone Health, New York, New York
| | - Rabia Ali de Latour
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | | | - Scott E Sherman
- Department of Population Health, NYU Langone Health, New York, New York
| | - Mengmeng Du
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter S Liang
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York. .,Veterans Affairs New York Harbor Health Care System, New York, New York
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16
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Rastogi N, Xia Y, Inadomi JM, Kwon SC, Trinh-Shevrin C, Liang PS. Disparities in colorectal cancer screening in New York City: An analysis of the 2014 NYC Community Health Survey. Cancer Med 2019; 8:2572-2579. [PMID: 30843666 PMCID: PMC6536964 DOI: 10.1002/cam4.2084] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background & Aims Disparities in colorectal cancer (CRC) screening uptake by race/ethnicity, socioeconomic status, and geography are well documented. We sought to further characterize the relationship between sociodemographic factors and up‐to‐date colonoscopy use in a diverse urban center using the 2014 New York City Community Health Survey (NYCCHS). Methods We examined overall colonoscopy uptake by race/ethnicity—with a particular interest in Asian and Hispanic subgroups—and used weighting to represent the entire 2014 NYC adult population. We also evaluated the association between 10 sociodemographic variables (age, sex, race/ethnicity, birthplace, home language, time living in the US, education, employment, income, and borough of residence) and colonoscopy use using univariable and multivariable logistic regression models. Results Up‐to‐date colonoscopy uptake was 69% overall with reported differences by racial/ethnic group, ranging from 44%‐45% for Mexicans and Asian Indians to 75% for Dominicans. In the multivariable regression model, colonoscopy use was associated with age greater than 65 years, Chinese language spoken at home, and not being in the labor force. Lower colonoscopy use was associated with living in the US for less than 5 years, Asian Indian language spoken at home, lower income, and residing outside of Manhattan. Conclusions Among New Yorkers older than age 50, up‐to‐date colonoscopy use varied significantly by race/ethnicity, especially in Asian and Hispanic subgroups. Recent immigrants, low‐income groups, and those living outside of Manhattan were significantly less likely to receive CRC screening. Targeted interventions to promote CRC screening in these underserved groups may improve overall screening uptake.
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Affiliation(s)
| | - Yuhe Xia
- NYU Langone Health, New York, New York
| | - John M Inadomi
- University of Washington School of Medicine, Seattle, Washington
| | | | | | - Peter S Liang
- NYU Langone Health, New York, New York.,VA New York Harbor Health Care System, New York, New York
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