Open-Access Colorectal Screening Finds More Polyps, Adenomas

Neil Osterweil

October 20, 2015

HONOLULU — A public–private partnership of patient navigators, gastroenterologists, and other healthcare providers — who collectively volunteer their time and skills — is bringing colorectal cancer screening to underserved, low-income populations.

"Over 50% of the gastroenterologists in our state participate, and not one of them gets compensated, and none of the practices that use anesthesiologists or anesthetists are compensated," said Renay Caldwell, CCRC, from the Center for Colon Cancer Research at the University of South Carolina in Columbia.

Caldwell is one of six patient navigators in South Carolina who guide economically disadvantaged patients through the process of colorectal cancer screening, educate them about the importance of screening, explain proper bowel prep, review their records, and follow-up to make sure that patients follow through.

The program is open to white adults 50 to 64 years of age and black adults 45 to 64 years of age who live at or below 150% of the federal poverty level, which is currently $17,655 for a single person. They must be asymptomatic, must have no history of colorectal neoplasia, and must not have undergone a colonoscopy in the previous decade.

 
We have only a 2% no-show rate state wide.
 

Patients are referred to the program by federally qualified health centers, free medical clinics, and primary healthcare clinics in urban and rural areas.

Caldwell reported a 1-year analysis of the program here at the American College of Gastroenterology 2015 Annual Meeting.

Of the 618 patients involved in the program who underwent colonoscopy, 37.1% were men, 62.9% were women, 52.7% were black, and 40.4% were white.

Remarkably, patients attended 98.0% of all endoscopic appointments, and the successful cecal intubation rate was 96.8% in those who underwent screening.

"We have only a 2% no-show rate state wide," Caldwell told Medscape Medical News.

Polyp detection rates were high — 67.2% for men and 61.2% for women. The rate of detectable polyps was significantly higher in white patients than in black patients (68.8% vs 57.1%).

The rate of detection of adenomas was significantly higher in men than in women (42.0% vs 32.3%; P = .04) and in white patients than in black patients (39.0% vs 32.4%; P = .015).

These findings indicate that "the molecular pathways to [colorectal cancer] may differ between the two races," Caldwell pointed out. In fact, she and her colleagues suggest that the differences warrant further research.

"It's really remarkable that by virtue of having integrated navigators, there would be such a high compliance rate," said Jordan Karlitz, MD, from the Tulane University School of Medicine in New Orleans, who was not involved in the study.

The results offer hope that the ambitious goal of having 80% of eligible adults undergo colorectal cancer screening by 2018, established by the National Colorectal Cancer Roundtable, will be met, Dr Karlitz told Medscape Medical News.

Eliminating Language Barriers

A separate study involved Spanish- and Vietnamese-speaking patients who attended bowel prep clinics conducted in their native languages.

The results were presented by Andrew Korson, MD, a GI fellow at the University of Washington in Seattle.

Bowel prep quality and colonoscopy completion were significantly better in this group of patients than in patients who received standard patient instruction, he reported.

"We know that if you do go to the prep clinic, you are by far more likely to attend a colonoscopy," Dr Korson told Medscape Medical News.

In fact, colonoscopy attendance was higher in those who attended the prep clinic than in those who did not for Spanish speakers (91% vs 69%) and for Vietnamese speakers (94% vs 67%).

The improvement in bowel prep quality can lead to more completions, said Sagar Shroff, MD, a gastroenterology fellow at the Emory University School of Medicine in Atlanta, who was not involved with the study.

"In a tertiary county hospital in Atlanta, we have noticed that patients who don't speak English tend to have poorer quality of bowel preps," he reported. And, of course, that "affects our efforts to deliver care."

Nationwide, the rates of Hispanic people, Asian people, and people of low socioeconomic status who undergo colorectal cancer screening is below 40%, according to Dr Korson and his colleagues.

The navigator study is supported by the Duke Endowment; the BlueCross, BlueShield of South Carolina Foundation; the State of South Carolina; and the National Institutes of Health. The bowel prep study was internally supported. The authors have disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2015 Annual Meeting: Abstracts P158 band P173. Presented October 18, 2015.

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