Abstract
Background
A community-based, colorectal cancer (CRC) screening program for uninsured/underinsured
individuals was successfully implemented in El Paso, Texas to increase CRC screening
rates. Our aim was to determine the colorectal neoplasia prevalence among program
participants and between screening groups.
Methods
We retrospectively reviewed participant records from 2012 to 2017. Average-risk patients
were first screened with a fecal immunochemical test (FIT) and included if positive.
Above average-risk patients due to a family history of CRC were referred directly
for screening colonoscopy. Patients were excluded if experiencing melena or hematochezia
or had a personal history of colon polyps or CRC.
Results
Of the 638 screening colonoscopies performed, 59.4% were in FIT-positive subjects
and 40.6% were in subjects with a family history of CRC. Patients were predominantly
female (72.9%), aged 50-65 years (84.2%), Hispanic (97.9%), and born in Mexico (92.4%).
Overall, the detection rate for polyps, adenomas, and advanced adenomas was 46.2%,
34.3%, and 11.1%, respectively. Fifteen patients had adenocarcinoma (2.4%). Compared
with colonoscopies in patients with a family history, FIT-positive patients demonstrated
a higher prevalence of polyps (PR 1.39, 95% CI 1.09-1.78), adenomas (PR 1.55, 95%
CI 1.15-2.07), advanced adenomas (PR 3.04, 95% CI 1.67-5.56).
Conclusions
This community-based CRC screening program in an enriched cohort of predominantly
Mexican Americans was effective in identifying colorectal neoplasia and cancer. Additionally,
there was an increased prevalence of colorectal neoplasia in average-risk, FIT-positive
patients undergoing screening colonoscopy compared with above average-risk patients
with a family history of CRC. Similar screening programs would likely benefit at-risk
populations.
Key Indexing Terms
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Article info
Publication history
Published online: April 06, 2022
Accepted:
March 31,
2022
Received:
May 25,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Colon cancer screening is for everyoneThe American Journal of the Medical SciencesVol. 364Issue 4
- PreviewColorectal cancer is the fourth most common new cancer diagnosis (excluding skin) in the United States with lifetime incidence rates of approximately 4%.1 With the recognition that cancers and large polyps may cause occult gastrointestinal bleeding, randomized trials in the early 1990s demonstrated that screening by fecal occult blood testing reduced colorectal cancer mortality.2 Subsequent investigations demonstrated that screening flexible sigmoidoscopy reduced both colorectal cancer incidence and mortality.
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