Abstract IA12: Follow-up of abnormal colorectal cancer screening: Challenges and solutions

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States but is largely preventable by screening. Both observational and randomized control trial data demonstrate that screening for CRC with colonoscopy, flexible sigmoidoscopy, or stool-based studies can effectively identify and remove premalignant lesions, reduce incidence of CRC, and decrease CRC mortality. Stool-based screening modalities like high-sensitivity fecal occult blood testing (FOBT) and fecal immunochemical testing (FIT) are inexpensive, noninvasive, and accessible screening modalities that are commonly used in underinsured and underserved patient populations. A major challenge of these stool-based methods, however, is that abnormal (i.e., positive) results are common (5-14%) and warrant subsequent follow-up with diagnostic colonoscopy to avoid poor CRC outcomes. Currently, follow-up rates across health care settings range from 40% to over 80%. Safety-net populations have the lowest rates at 40% to 58%, substantially shy of the national benchmark to achieve colonoscopy in 80% of patients with abnormal results. These low rates reflect patient-, provider-, and system-level barriers to diagnostic colonoscopy after positive screening and a lack of clinical resources and optimal system processes to facilitate access to and patient utilization of diagnostic colonoscopy. The goals of this talk are to (1) provide an overview of low follow-up after abnormal CRC screening, with a focus on Federally Qualified Health Centers (FQHCs) and safety-net institutions; (2) summarize the available data on barriers to follow-up after an abnormal screening result; and (3) present an overview of effective interventions to improve the timelines of follow-up colonoscopy and colonoscopy follow-up rates. The presentation will also address directions for future research in follow-up after abnormal CRC screening.

Citation Format: Folasade P. May. Follow-up of abnormal colorectal cancer screening: Challenges and solutions [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA12.