Cancer prevention efficacy of PCP-performed vs. specialist-performed screening colonoscopies under an innovative program in South Carolina

Background: Colonoscopy remains the gold standard screening tool for primary prevention (preventing 60-90% of cancers in average risk individuals), The current 50% specialist shortage calls for innovative workforce approaches to expand colonoscopy screening capacity to reach underserved populations, particularly African Americans (AA), AAs suffer disproportionately greater CRC incidence and mortality. A licensed endoscopy center in South Carolina has implemented a unique program to train primary care physicians (PCP) in colonoscopy and facilitate post-training performance by providing onsite technical and specialist support, together with a state-of-art colonoscopy performance protocol. Previous research shows that the center disproportionately serves AA clients, results in high colonoscopy screening rates among PCPs' patients, and achieves high adenoma detection rates similar to autopsy studies (the gold standard). This study extends the evidence by documenting the cancer protection efficacy achieved with PCP-performed colonoscopies relative to specialists. Objective: To compare the cancer protection efficacy of PCP-performed screening colonoscopies (with technical and specialist backup support) with that of specialist-performed colonoscopies at the same center. Methods: Longitudinal follow-up data from a large well-documented South Carolina on 24,047 screening colonoscopies (19,147 performed by 58 PCPs and 4,900 by specialist/ colonoscopy expert) with about 106,900 person years of observation. These data were linked to the gold-rated South Carolina Central Cancer Registry to identify subsequent cancer incidence among these patients. A 2% chart review showed high accuracy of the database. Incident colon and rectum cancers found in the Registry following colonoscopy will be classified by probable cause as missed cancer, new cancer, incomplete removal, failed biopsy detection, and incomplete colonoscopy, using data on months/years since colonoscopy, lesion types and procedure notes at colonoscopy, and location of the cancer. Cleaned data are currently under analysis. We will study standardized incidence ratios (SIR) among the PCP and specialist case cohorts using as the reference group the general population age- sex-specific incidence rates of the National Program of Cancer Registries (NPCR)during the calendar years representing the mid point of accrual and follow-up for our study cohort Implications for Health Disparities Policy, Delivery or Practice: Currently the need for 23 million colonoscopies vs, current specialist capacity to perform 12 million procedures, translates to 7340 additional gastroenterologists needed, whereas only 380 specialists graduate each year. This calls for innovative workforce approaches. Our study will provide the ultimate empirical outcome validation of a innovative PCP utilization model that is documented to disproportionately reach out to the AA population.