199075 A feasibility study about increasing colon cancer screening: How to say “yes” even to the uninsured and under-insured

Wednesday, November 11, 2009: 11:15 AM

Alexis A. Moore, MPH , Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Cathy L. Melvin, PhD , Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, Chapel Hill, NC
Katya Roytburd, MPH, CHES , Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: Annual Fecal Immunochemical Test (FIT) is among the colorectal cancer (CRC) screening tests recommended by US Preventive Services Task Force and leading cancer organizations. A public health, health care and research consortium formed to assess the feasibility of implementing a low-cost CRC screening program for under- and uninsured average risk individuals age 50 or over. Methods: Eligible individuals (n=300) seen at three free or low-cost healthcare sites received a 3-sample FIT. A subgroup (n=200) was enrolled in a randomized control trial (RCT) comparing test completion rates for two versions of FIT: repackaged (intervention) FIT informed by local focus group findings; and conventional FIT (control). Telephone surveys with 16 RCT participants assessed barriers and facilitators to using each FIT. SAS V9.1 was used to generate descriptive statistics and p values. Results: FIT completion rates varied by distribution site (39%, 68%, 78%), with an overall rate of 64%. No significant difference was found between intervention and control completion rates, 69% and 65%, respectively. Two positive FIT results required diagnostic follow up. Conclusions: Return rates in this study population are higher than indicated in the research literature. FIT completion rates of 68% and 78% at two clinics for patients at or below 225% and 100% of the federal poverty level, respectively, indicate an important role for “free clinics” in closing the screening gap between insured and uninsured. Use of a 3-sample FIT with high specificity, compared with a guaiac stool test, may reduce the number of false-positives requiring follow-up colonoscopy.

Learning Objectives:
1) Name the colorectal cancer screening tests approved, for average risk individuals, by the US Preventive Services Task Force. 2) Identify at least two populations with colorectal cancer screening rates below the national screening average. 3) Discuss three barriers to colorectal cancer screening and possible strategies to overcome them.

Keywords: Cancer Screening, Evidence Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As project director of the UNC’s Collaborating Center in the Comprehensive Cancer Control Research Network I gave extensive assistance develop the intervention and directly supervised its implementation and data analysis. I have a masters in public health and am also the facility director of the University’s NCI-funded Dissemination Core, focused on assisting investigators plan, implement and evaluate dissemination and implementation studies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.