This figure shows prevalence of unsatisfactory FIT over the study period

This table shows results of sensitivity analysis - Factors associated with subsequent testing within 9 months among patients with unsatisfactory fecal immunochemical test

This table shows subsequent testing patterns within 15 months after an unsatisfactory FIT

This table tabulates reasons for unsatisfactory FIT based on free-text responses entered by laboratory technician in EHR

This figure depicts reasons for unsatisfactory FIT based on type of FIT

This table presents predictors of unsatisfactory FIT, stratified by type of test

AbstractBackground: Fecal immunochemical test (FIT) is an effective colorectal cancer screening modality. Little is known about prevalence, reasons, and testing after unsatisfactory FIT, or a FIT that cannot be processed by the laboratory due to inadequate stool specimen or incomplete labeling. Methods: Our retrospective cohort study examined unsatisfactory FIT among average-risk individuals aged 50–74 years in a large, integrated, safety-net health system who completed an index FIT from 2010 to 2019. We determined prevalence of unsatisfactory FIT and categorized reasons hierarchically. We used multivariable logistic regression models to identify factors associated with: (i) unsatisfactory FIT; and (ii) subsequent testing within 15 months of the unsatisfactory FIT. Results: Of 56,980 individuals completing an index FIT, 10.2% had an unsatisfactory FIT. Reasons included inadequate specimen (51%), incomplete labeling (27%), old specimen (13%), and broken/leaking container (8%). Unsatisfactory FIT was associated with being male [OR, 1.10; confidence interval (CI), 1.03–1.16], Black (OR, 1.46; CI, 1.33–1.61), Spanish speaking (OR, 1.12; CI, 1.01–1.24), on Medicaid (OR, 1.42; CI, 1.28–1.58), and received FIT by mail (OR, 2.66; CI, 2.35–3.01). Among those with an unsatisfactory FIT, fewer than half (41%) completed a subsequent test within 15 months (median, 4.4 months). Adults aged 50–54 years (OR, 1.16; CI, 1.01–1.39) and those who received FIT by mail (OR, 1.92; CI, 1.49–2.09) were more likely to complete a subsequent test. Conclusions: One in ten returned a FIT that could not be processed, mostly due to patient-related reasons. Fewer than half completed a subsequent test after unsatisfactory FIT. Impact: Screening programs should address these breakdowns such as specimen collection and labeling to improve real-world effectiveness. See related In the Spotlight, p. 183

Despite national policy efforts to increase colorectal cancer (CRC) screening, rates in vulnerable populations remain suboptimal. Many types of interventions have been employed, but their impact on improving population-level rates of CRC screening over time is uncertain. Assess the impact of 10 years of different in-reach and outreach strategies to improve CRC screening and identify factors associated with being screen up-to-date (SUTD). Observational cohort study. Patients aged 50–74 years from 12 community-based primary care clinics in an integrated, regional safety-net health system. Multiple system-level interventions were implemented over time (visit-based electronic health record [EHR] reminders, quality measurement, annual preventive service letters, and mailed fecal immunohistochemical stool tests [FIT]). CRC SUTD rates by calendar year among those with a primary care (PC) visit in the prior 1 and 3 years and their multivariable correlates. The sample included 31,786–40,405 patients/year. In 2011, mean age was 58.9, 63.9

Introduction: Colorectal cancer (CRC) screening is an effective secondary prevention method with an increased probability of diagnosing CRC at an earlier stage, and a consequent improvement in survival post-treatment. This is especially true for individuals who undergo guideline recommended screening at appropriate intervals. Studies have reported a consistent rise in long-term trends of guideline-adherent screen-up-to-date (SUTD) rates among predominantly White and insured individuals. Here we use longitudinal data from 2011-2020 and report 10-year prevalence and correlates of CRC SUTD among patients in a safety-net health system. Methods: All patients aged 50-74 years who had a primary care encounter in any of the 12 community clinics in a large county safety-net health system were included. An individual was considered to be SUTD if he/she had a stool test during the calendar year, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. To obtain a population health estimate (and not only examine frequencies), we included in the denominator patients with a primary care visit in the past 3 years. Multivariable generalized estimating equations (GEE) model was used to examine the association of SUTD status with time-varying demographic and clinical characteristics over the 10-year period. Results: Our analytical cohort had 50,647 patients in 2011, of which 40.9% (20,708) patients were SUTD. Annual rates of SUTD were largely unchanged until 2019, when the prevalence increased to 46.8% after initiation of a population health outreach mailed FIT program. The SUTD rate fell to the baseline level of 40.8% in 2020 after the pandemic-induced suspension of the mailed FIT program. Multivariable GEE model demonstrated that older patients, females, and Hispanics had higher odds of being SUTD compared to younger patients, males, and non-Hispanics, respectively. Additionally, patients who had prior interaction with the healthcare system (had prior stool tests or prior primary care encounters) had higher odds of being SUTD than those with no prior experience with the healthcare system (no prior stool tests or no prior primary care encounters). Conclusion: This study establishes contemporary evidence about the 10-year prevalence and correlates of CRC SUTD status among patients in a safety-net health system. Prevalence remained constant for most of the decade, except in 2019, when a population-based mailed FIT outreach program was implemented to complement usual visit-based screening. Despite the disruptions caused by the COVID-19 pandemic, screening rates in 2020 did not drop below pre-2019 levels (~40%), though the prior increases due to the mailed FIT program were lost. We believe that effective implementation of broad population-based, screening outreach efforts are instrumental in improving and sustaining CRC SUTD rates in safety-net health systems, and can consequently help to decrease CRC incidence and related mortality. Citation Format: Rasmi G. Nair, Ellen Hu, Lei Wang, Eric Kim, Cynthia Ortiz, Jacquelyn Lykken, Celette S. Skinner, Ethan Halm. Colorectal cancer screen-up-to-date: 10-year prevalence in a regional safety-net health system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A109.