Fecal-Based Colorectal Cancer Screening Among the Uninsured in Northern Manhattan

Abstract

Background Colorectal cancer (CRC) screening reduces CRC mortality; however, for many reasons, uninsured individuals are less likely to utilize CRC screening tests. Purpose To compare CRC screening behaviors and outcomes with guaiac fecal occult blood testing (gFOBT) from 1998 to 2006 and fecal immunochemical testing (FIT) from 2006 to 2010 in a community-based program serving uninsured patients in northern Manhattan. Methods In 2013, we conducted a retrospective record review of individuals aged ≥50 years who received fecal-based CRC screening at the Northern Manhattan Cancer Screening Partnership between 1998 and 2010. Included were those with household income ≤250% of the federal poverty level, no medical insurance coverage, and who were not up to date with CRC screening. We assessed screening positivity rate, positive predictive value, differences in the use of diagnostic colonoscopy, colonoscopic findings, and adenoma detection rates for gFOBT versus FIT. Results In total, 7,710 patients completed CRC screenings (4,951 gFOBT and 2,759 FIT). The majority were female, Hispanic, foreign born, and young at age of first screening. Compared to gFOBT, FIT detected twice as many positive tests (3.2% vs 1.5%, p≤0.001) and had a higher adenoma detection rate (18.2 vs 11.8, p=0.002). Conclusions The improved positivity and adenoma detection rates with greater number of screening tests over time favor the use of FIT over gFOBT for colorectal screening among uninsured populations in northern Manhattan.

Timeliness of Colonoscopy After Abnormal Fecal Test Results in a Safety Net Practice

“…Compared with community health centers that have used FITs, our follow-up colonoscopy adherence rate was lower than that found by Hillyer et al[18] (84.2% over 4 years in northern Manhattan) and LoConte et al[19] (91% over 2 years in Wisconsin). However, a similar adherence rate was found in a study by Levy et al[20] (61% in Iowa; time frame not stated).…”

“…Compared with other CRC screening programs that used either FOBT or FIT as a primary CRC screening tool, our study’s follow-up colonoscopy adherence rate of 57% after a positive FIT result was moderate [12, 18–21]. Compared with community health centers that have used FITs, our follow-up colonoscopy adherence rate was lower than that found by Hillyer et al[18] (84.2% over 4 years in northern Manhattan) and LoConte et al[19] (91% over 2 years in Wisconsin).…”

The fecal immunochemical test (fit): Selected aspects regarding its effectiveness for colorectal cancer screening in Quebec City

“…To our knowledge, this is the first FIT performance assessment to be performed in the province of Quebec. It has already been evaluated elsewhere in Canada and worldwide under various screening programs ( Major et al, 2013 ; Jensen et al, 2016 ; McNamara et al, 2014 ; Shah et al, 2014 ; Kapidzic et al, 2014 ; Hillyer et al, 2014 ; Redwood et al, 2014 ; Bujanda et al, 2014 ; Steele et al, 2013 ; Chubak et al, 2013 ; Bujanda et al, 2013 ; Parente et al, 2013 ; Parente et al, 2012 ; Faivre et al, 2012 ; Crotta et al, 2012 ; van Roon et al, 2013 ; Mandelli et al, 2011 ; Parente et al, 2009 ; van Rossum et al, 2008 ; Ciatto et al, 2007 ). It is difficult to compare our results with those previously published, because study designs are heterogeneous.…”

Where does it FIT? The roles of fecal testing and colonoscopy in colorectal cancer screening

“…This relatively simple and cheap test has generally been proposed for mass population screening in contrast to individual screening . When an organization or health agency seeks to screen a large population (particularly a disadvantaged population) that may or may not have had contact with a primary caregiver, the test of choice most often is a stool‐based one (most recently FIT) . In the United States, Kaiser Permanente of Northern California and the Veterans Administration have been using FIT for their members who have not sought annual checkups.…”

“…Because organized CRC screening programs provide the fecal test via postal mail, they do not require contact with the health care system and are well suited to populations lacking or having limited access to medical facilities. They have been particularly adept at reaching poor and geographically and linguistically isolated populations and attaining high levels of compliance and repeated testing over time . The effectiveness of such programs in screening large numbers of individuals who might otherwise never be screened and in facilitating repeated testing over time challenges the notion that the highly sensitive colonoscopy is the only test with which to screen for CRC on a population basis.…”