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Background: Accurate clinical staging is crucial to managing gastrointestinal cancer, but fluorine 18 (18 F) fluorodeoxyglucose (FDG) PET/CT has limitations. Targeting fibroblast-activation protein is a newer diagnostic approach for the visualization of tumor stroma, and gallium 68 (68 Ga)-labeled fibroblast-activation protein inhibitors (FAPIs), hereafter 68 Ga-FAPIs, present a promising alternative to 18 F-FDG. Purpose: To compare the diagnostic efficacy of 68 Ga-FAPI PET/CT in primary and metastatic lesions of gastrointestinal malignancies with that of 18 F-FDG PET/CT. Materials and Methods: Images from patients with gastric, duodenal, and colorectal cancers who underwent contemporaneous 18 F-FDG and 68 Ga-FAPI PET/CT between October 2019 through June 2020 were retrospectively analyzed. 18 F-FDG and 68 Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. The McNemar test was used to compare the diagnostic performance between the two techniques. Results: Thirty-five patients (median age, 64 years [interquartile range, 53-68 years]; 18 men) were evaluated. In treatment-naive patients (n = 19), 68 Ga-FAPI PET/CT led to upstaging of the clinical TNM stage in four (21%) patients compared with 18 F-FDG PET/CT. Tracer uptake was higher with 68 Ga-FAPI PET/CT than with 18 F-FDG PET/CT in primary lesions (gastric cancer: 12.7 vs 3.7, respectively, P = .003; colorectal cancer: 15.9 vs 7.9, P = .03), involved lymph nodes (6.7 vs 2.4, P , .001), and bone and visceral metastases (liver metastases: 9.7 vs 5.2, P , .001; peritoneal metastases: 8.4 vs 3.6, P , .001; bone metastases: 4.3 vs 2.2, P , .001; lung metastases: 4.4 vs 1.9, P = .01). In addition, the sensitivity of 68 Ga-FAPI PET/CT was higher than that of 18 F-FDG PET/CT in the detection of primary tumors (100% [19 of 19] vs 53% [10 of 19], respectively; P = .004), lymph nodes (79% [22 of 28] vs 54% [15 of 28], P , .001), and bone and visceral metastases (89% [31 of 35] vs 57% [20 of 35], P , .001). Conclusion: Gallium 68 fibroblast-activation protein inhibitor PET/CT was superior to fluorine 18 fluorodeoxyglucose PET/CT in the detection of primary and metastatic lesions in gastric, duodenal, and colorectal cancers, with higher tracer uptake in most primary and metastatic lesions. Published under a CC BY 4.0 license.

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Racial and ethnic disparities in colorectal cancer screening have been documented extensively in the literature. In July 2001 Medicare began covering colonoscopy for average-risk beneficiaries. We examined the effect of Medicare reimbursement on the rate and disparity of colorectal cancer screening among the elderly in the United States. This policy alleviated the screening disparity between non-Hispanic whites and blacks, but the gap between Hispanics and non-Hispanic whites has widened. Overall, fewer than half of the elderly are screened, even though Medicare now covers colonoscopy.

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Objectives Numerous studies have documented disparities in health care utilization between non-Hispanic White and minority elders. We investigated differences in anti-dementia medication use between non-Hispanic White and minority community-dwelling Medicare beneficiaries with dementia. Methods Using multivariate analysis with generalized estimating equations, we estimated prevalence ratios (PRs) for anti-dementia medication use by race/ethnicity for 1,120 beneficiaries with dementia from years 2001 through 2003 of the Medicare Current Beneficiary Survey. Results After adjusting for demographics, socioeconomics, health care access and utilization, comorbidities, and service year, we found that anti-dementia medication use was approximately 30% higher among non-Hispanic Whites compared to other racial/ethnic groups (PR = 0.73, 95% confidence interval [CI] = 0.59, 0.91). As for individual racial/ethnic groups, prevalence disparities remained significant for non-Hispanic Blacks (PR = 0.75, 95% CI = 0.57, 0.99) and non-Hispanic others (PR = 0.50, 95% CI = 0.26, 0.96) but were attenuated for Hispanics (PR = 0.84, 95% CI = 0.59, 1.20). Discussion Results provide evidence that racial/ethnic disparities in utilization of drugs used to treat dementia exist and are not accounted for by differences in demographic, economic, health status, or health utilization factors. Findings provide a foundation for further research that should use larger numbers of minority patients and consider dementia type and severity, access to specialty dementia care, and cultural factors.