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ObjectiveFactors that lead to metabolic dysregulation are associated with increased risk of early-onset colorectal cancer (CRC diagnosed under age 50). However, the association between metabolic syndrome (MetS) and early-onset CRC remains unexamined.DesignWe conducted a nested case–control study among participants aged 18–64 in the IBM MarketScan Commercial Database (2006–2015). Incident CRC was identified using pathologist-coded International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and controls were frequency matched. MetS was defined as presence of ≥3 conditions among obesity, hypertension, hyperlipidaemia and hyperglycaemia/type 2 diabetes, based on ICD-9-CM and use of medications. Multivariable logistic regressions were used to estimate ORs and 95% CIs.ResultsMetS was associated with increased risk of early-onset CRC (n=4673; multivariable adjusted OR 1.25; 95% CI 1.09 to 1.43), similar to CRC diagnosed at age 50–64 (n=14 928; OR 1.21; 95% CI 1.15 to 1.27). Compared with individuals without a metabolic comorbid condition, those with 1, 2 or ≥3 conditions had a 9% (1.09; 95% CI 1.00 to 1.17), 12% (1.12; 95% CI 1.01 to 1.24) and 31% (1.31; 95% CI 1.13 to 1.51) higher risk of early-onset CRC (ptrend <0.001). No associations were observed for one or two metabolic comorbid conditions and CRC diagnosed at age 50–64. These positive associations were driven by proximal (OR per condition 1.14; 95% CI 1.06 to 1.23) and distal colon cancer (OR 1.09; 95% CI 1.00 to 1.18), but not rectal cancer (OR 1.03; 95% CI 0.97 to 1.09).ConclusionsMetabolic dysregulation was associated with increased risk of early-onset CRC, driven by proximal and distal colon cancer, thus at least in part contribute to the rising incidence of early-onset CRC.

Medical schools and health care institutions should establish guidelines for students who identify as fluent in another language and are interested in interpreting for LEP patients in clinical settings, to protect both students and patients when language poses a barrier to quality care.

Background Advocacy is often described as a pillar of the medical profession. However, the impact of advocacy training on medical students’ identity as advocates in the medical profession is not well-described. Aim/Setting/Participants We sought to introduce an advocacy curriculum to a mandatory Health Care Disparities (HCD) course for 88 first year medical students. Program Description The 2013 HCD added advocacy curriculum that included: guest lecturers’ perspectives on their advocacy experience; reflective essay assignments assessing self-identify as an advocate; advocacy-specific lectures and large group discussions; and participation in small group community projects. Evaluation A mixed methods approached was used to evaluate 88 first year medical students’ advocacy themed reflective essays, independently coded by three investigators, and Likert-response questions were compared to published benchmarked items. The IRB exempted this study. Analysis of student essays revealed that students were better able to identify as an advocate in medicine. The survey also revealed that 86% post-course vs. 73% precourse agreed/strongly agreed with the statement: “I consider myself an advocate” (p=0.006). Discussion Exposing all medical students to advocacy within medicine may help shape and define their perceived professional role. Future work will explore adding advocacy and leadership skill training to the HCD course.

This low-cost, high-quality, program can be undertaken by medical schools interested in promoting a diverse workforce that may ultimately begin to address and reduce health care disparities.

Background Prompt detection of colorectal cancer under age 50 (early-onset CRC) is a clinical priority due to its alarming rise. Methods We conducted a matched case-control study of 5075 incident early-onset CRC among U.S. commercial insurance beneficiaries (113 million adults aged 18-64) with ≥2 years of continuous enrollment (2006-2015) to identify red-flag signs/symptoms between 3 months to 2 years before the index date among 17 pre-specified signs/symptoms. We assessed diagnostic intervals according to the presence of these signs/symptoms before and within 3 months of diagnosis. Results Between 3 months to 2 years before the index date, four red-flag signs/symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with ORs ranging from 1.34 to 5.13. Having 1, 2, or ≥ 3 of these signs/symptoms were associated with a 1.94 (95% CI, 1.76 to 2.14), 3.59 (2.89 to 4.44), and 6.52 (3.78 to 11.23)-fold risk (Ptrend &lt; .001), with stronger associations for younger ages (Pinteraction &lt; .001) and rectal cancer (Pheterogenity=0.012). The number of different signs/symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. About 19.3% of cases had their first sign/symptom occur between 3 months to 2 years before diagnosis (median diagnostic interval: 8.7 months), and around 49.3% had the first sign/symptom within 3 months of diagnosis (median diagnostic interval: 0.53 month). Conclusions Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, or iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.

Objective The Chicago south side, even more so than national populations, continues to be burdened with widening gaps of disparities in cancer outcomes. Therefore, Chicago community members were engaged in addressing the following content areas for a cancer disparities curriculum: (1) the south side Chicago community interest in participating in curriculum design, (2) how community members should be involved in designing cancer disparities curriculum, and (3) what community members believe the curriculum should address to positively impact their community. Methods Eighty-six community members from 19 different zip code areas of Chicago attended the deliberative session. A survey composed of three quantitative and three short-answer content questions was analyzed. Results The majority of participants were from the south side of Chicago (62 %) and females (86 %). Most, 94 %, believed community members should be involved in cancer disparities curriculum development. Moreover, 56 % wanted to be involved in designing the curriculum, and 61 % reported an interest in taking a course in cancer disparities. Three categorical themes were derived from the qualitative questions: (1) community empowerment through disparities education—“a prescription for change,” (2) student skill development in community engagement and advocacy training, and (3) community expression of shared experiences in cancer health disparities. Conclusion The community provided valuable input for cur-ricular content and has an interest in collaborating on cancer disparities curriculum design. Community participation must be galvanized to improve disparities curricular development and delivery to successfully address the challenges of eliminating disparities in health.

In an AA population, post-colonoscopy polyp recall rates were similar to those described in white populations. Uninsured patients who completed PN were more likely than insured usual care patients to accurately report the presence of polyps on colonoscopy.