scholarly journals Framework and Strategies to Eliminate Disparities in Colorectal Cancer Screening Outcomes

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Chyke A. Doubeni ◽  
Kevin Selby ◽  
Samir Gupta
Keyword(s):  
Colorectal Cancer ◽  
Community Engagement ◽  
Health Equity ◽  
Screening Tests ◽  
Annual Review ◽  
Publication Date ◽  
Structural Barriers ◽  
Screening Process ◽  
Crc Screening ◽  
Racial Ethnic

Preventable differences in colorectal cancer (CRC) mortality across racial/ethnic, economic, geographic, and other groups can be eliminated by assuring equitable access and quality across the care continuum, but few interventions have been demonstrated to do so. Multicomponent strategies designed with a health equity framework may be effective. A health equity framework takes into account social determinants of health, multilevel influences (policy, community, delivery, and individual levels), screening processes, and community engagement. Effective strategies for increasing screening uptake include patient navigation and other interventions for structural barriers, reminders and clinical decision support, and data to continuously track metrics and guide targets for improvement. Community resource gaps should be addressed to assure high-quality services irrespective of racial/ethnic and socioeconomic status. One model combines population-based proactive outreach screening with delivery screening at in-person or virtual points of contact, as well as community engagement. Patient- and provider-based behavioral interventions may be considered for increasing screening demand and delivery. Providing a choice of screening tests is recommended for CRC screening, and access to colonoscopy is required for completion of the CRC screening process. Expected final online publication date for the Annual Review of Medicine, Volume 72 is January 27, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Persistent Barriers to Colorectal Cancer Screening Completion Amid Centralized Outreach: A Mixed Methods Study

2021 ◽  
pp. 089011712110644
Author(s):  
Jocelyn V. Wainwright ◽  
Shivan J. Mehta ◽  
Alicia Clifton ◽  
Claire Bocage ◽  
Shannon N. Ogden ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Comparative Method ◽  
Pragmatic Trial ◽  
Behavioral Model ◽  
Structural Barriers ◽  
Crc Screening ◽  
Non Invasive ◽  
Interview Guide ◽  
Timely Completion ◽  
Immunochemical Test

Purpose To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices. Approach Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire. Setting Single urban academic healthcare system. Participants Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment. Method Using Andersen’s Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method. Results Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening. Conclusions Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.

The Role of Citizen Science in Promoting Health Equity

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Lisa G. Rosas ◽  
Patricia Rodriguez Espinosa ◽  
Felipe Montes Jimenez ◽  
Abby C. King
Keyword(s):  
Public Health ◽  
Citizen Science ◽  
Health Equity ◽  
Healthy Eating ◽  
Mobile Applications ◽  
Health Inequities ◽  
Annual Review ◽  
Publication Date ◽  
Scientific Process

While there are many definitions of citizen science, the term usually refers to the participation of the general public in the scientific process in collaboration with professional scientists. Citizen scientists have been engaged to promote health equity, especially in the areas of environmental contaminant exposures, physical activity, and healthy eating. Citizen scientists commonly come from communities experiencing health inequities and have collected data using a range of strategies and technologies, such as air sensors, water quality kits, and mobile applications. On the basis of our review, and to advance the field of citizen science to address health equity, we recommend ( a) expanding the focus on topics important for health equity, ( b) increasing the diversity of people serving as citizen scientists, ( c) increasing the integration of citizen scientists in additional research phases, ( d) continuing to leverage emerging technologies that enable citizen scientists to collect data relevant for health equity, and ( e) strengthening the rigor of methods to evaluate impacts on health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Preferences of Iranian average risk population for colorectal cancer screening tests

2019 ◽  
Vol 32 (4) ◽  
pp. 677-687
Author(s):  
Vajiheh Ramezani_Doroh ◽  
Alireza Delavari ◽  
Mehdi Yaseri ◽  
Sara Emamgholipour Sefiddashti ◽  
Ali Akbarisari
Keyword(s):  
Colorectal Cancer ◽  
Health Status ◽  
Discrete Choice ◽  
Choice Model ◽  
Screening Tests ◽  
Average Risk ◽  
Risk Population ◽  
Content Type ◽  
Crc Screening ◽  
Complication Risk

Purpose The purpose of this paper is to explore the preferences of the average risk Iranian population for colorectal cancer (CRC) screening tests. Design/methodology/approach A standard stated-preferences method with discrete choice models was used to identify the preferences. Data about socio-demographic status, health status and preferences for CRC screening tests were collected by a structured questionnaire that was completed by 500 people aged 50–75 years. Mixed logit model was used to analyze the preferences. Findings The regression model showed that the test process, pain, place, frequency, preparation, sensitivity, complication risk, mortality rate and cost were the final attributes; that had a statistically significant correlation with the preferences of the people in choosing CRC screening tests. The socio-demographic and health status of participants had no significant correlation with the individuals’ preferences. Practical implications This study provides insight into how different characteristics of a CRC screening test might influence the preferences of individuals about that test. Originality/value This was the first study of this type in Iran to elicit the preferences of the average risk population for CRC screening tests using a discrete choice model.

Characteristics and attitudes of first round invitees in the Irish National Colorectal Cancer Screening Programme

2020 ◽  
pp. flgastro-2020-101417
Author(s):  
Susanne M O'Reilly ◽  
Katie N Hughes ◽  
Therese Mooney ◽  
Patricia Fitzpatrick ◽  
Diarmuid O'Donoghue ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Programme ◽  
Health Belief ◽  
Screening Process ◽  
Crc Screening ◽  
Cancer Screening Programme ◽  
Serious Disease ◽  
Fear Of Cancer ◽  
Belief Model ◽  
Risk Of Cancer

Background/objectiveColorectal cancer (CRC) screening is proven to reduce CRC-related mortality. Faecal immunochemical testing (FIT)-positive clients in the Irish National CRC Screening Programme underwent colonoscopy. Round 1 uptake was 40.2%. We sought to identify barriers to participation by assessing knowledge of CRC screening and examining attitudes towards FIT test and colonoscopy.MethodsQuestionnaires based on a modified Champion’s Health Belief Model were mailed to 3500 invitees: 1000 FIT-positive, 1000 FIT-negative and 1500 non-participants. 44% responded: 550 (46%) FIT-positive, 577 (48%) FIT-negative and 69 (6%) non-responders (NR).Results25% of respondents (n=286) did not perceive a personal risk of cancer, did not perceive CRC to be a serious disease and did not perceive benefits to screening. These opinions were more likely to be expressed by men (p=0.035). One-fifth (n=251) found screening stressful. Fear of cancer diagnosis and test results were associated with stress. FIT-positive clients, women and those with social medical insurance were more likely to experience stress.ConclusionsThe CRC screening process causes stress to one-fifth of participants. Greater use of media and involvement of healthcare professionals in disseminating information on the benefits of screening may lead to higher uptake in round 2.

Patterns of diagnosis for colorectal cancer (CRC): Screening detected versus symptomatic presentation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1023-1023
Author(s):  
S. R. Smiljanic ◽  
S. Gill
Keyword(s):  
Colorectal Cancer ◽  
British Columbia ◽  
Health Care Access ◽  
Screening Test ◽  
Distal Colon ◽  
Screening Tests ◽  
Crc Screening ◽  
Care Access ◽  
New Diagnosis ◽  
Screening History

1023 Background: Colorectal cancer (CRC) is a leading cause of cancer death in North America; studies have shown that screening improves survival. Conducted in British Columbia, Canada, this study was conducted to identify the proportion of screening-eligible patients with sporadic CRC who are detected by screening tests versus symptomatic presentation,and to compare baseline patient and tumor characteristics of these two groups. Methods: This retrospective cohort study identified 571 cases via the BC Cancer Registry of patients age 50 years and older presenting with first diagnosis of invasive CRC between Nov. 2002 and Apr. 2003. Patients with non-adenocarcinoma histology, HNPCC or FAP were not included. Self completed questionnaires were mailed to all patients to capture: prior screening history, screening versus symptomatic presentation, and demographic information. All respondents charts were then reviewed to corroborate screening information, and to obtain pathological information including TNM stage, grade and site (proximal versus distal colon versus rectal). Results: Of 212 eligible respondents (37% response), only 14 of 212 (6.6%) patients with a new CRC were detected via screening versus 198 of 212 (93.4%) presenting with symptoms. Respondents were average age at diagnosis 69 years, 59% male, 91% Caucasian, 37%rectal, and 18% M1 at diagnosis. No significant differences in the age, gender, ethnicity, socioeconomic status, tumour stage and site were detected between the screened versus symptomatic groups. Only 33 of 212 patients (15.6%) reported ever having a screening test. 19 of 198 cancers (9.6%) were diagnosed by symptomatic presentation despite a compliant screening history. Conclusion: Despite universal health-care access in British Columbia, only 7% of patients with a new diagnosis of CRC were detected via a screening test. Furthermore, only 15% of screening-eligible respondents have ever been screened. There were no differences in patient demographics or stage of disease at presentation but numbers in the screening cohort were limited. Significant effort is required to increase knowledge and compliance for CRC screening. No significant financial relationships to disclose.

scholarly journals Colorectal cancer screening behaviors among South Asian immigrants in Canada: a qualitative study

2015 ◽  
Vol 11 (2) ◽  
pp. 130-146 ◽  
Author(s):  
Joanne Crawford ◽  
Farah Ahmad ◽  
Dorcas E. Beaton ◽  
Arlene S. Bierman
Keyword(s):  
Colorectal Cancer ◽  
Focus Groups ◽  
South Asian ◽  
Cultural Context ◽  
Future Research ◽  
Average Risk ◽  
Collaborative Partnerships ◽  
Structural Barriers ◽  
Content Type ◽  
Crc Screening

Purpose – The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants. Design/methodology/approach – Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques. Findings – Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access. Originality/value – Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.

scholarly journals Towards Novel Non-Invasive Colorectal Cancer Screening Methods: A Comprehensive Review

2021 ◽  
Author(s):  
Allegra Ferrari ◽  
Isabelle Neefs ◽  
Sarah Hoeck ◽  
Marc Peeters ◽  
Guido Van Hal
Keyword(s):  
Colorectal Cancer ◽  
Early Stage ◽  
Screening Tests ◽  
Screening Methods ◽  
Exhaled Breath ◽  
Sample Collection ◽  
Screening Programs ◽  
Crc Screening ◽  
Low Sensitivity ◽  
Standard Colonoscopy

Colorectal cancer (CRC) is one of the leading cancer-related causes of death in the world. Since the 70s, many countries have adopted different CRC screening programs which has resulted in a decrease in mortality. However, current screening test options still present downsides. The commercialized stool-based tests present high false-positive rates and low sensitivity, which negatively affects the detection of early stage carcinogenesis. The gold standard colonoscopy has low uptake due to its invasiveness and the perception of discomfort and embarrassment that the procedure may bring.In this review, we collected and described the latest data about alternative CRC screening techniques that can overcome these disadvantages. Web of Science and PubMed were employed as search engines for studies reporting on CRC screening tests and future perspectives. The searches generated 555 articles, of which 93 titles were selected. Finally, a total of 50 studies, describing 14 different CRC alternative tests, were included. Among the investigated techniques the main feature that could have an impact on CRC screening perception and uptake was the ease of sample collection. Urine, exhaled breath and blood-based tests promise to achieve good diagnostic performance (sensitivity of 63-100%, 90-95%, 47-97%, respectively) while minimizing stress and discomfort for the patient.

scholarly journals Noninvasive diagnostics for colorectal cancer: molecular genetic fecal DNA analysis

2014 ◽  
Vol 21 (3) ◽  
pp. 8-12
Author(s):  
G. M. Butrovich ◽  
E. D. Mirlina ◽  
I. G. Habarova ◽  
O. A. Vostrukhina
Keyword(s):  
Colorectal Cancer ◽  
Large Scale ◽  
Dna Analysis ◽  
Molecular Genetic ◽  
Occult Blood ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Fecal Dna ◽  
Noninvasive Diagnostics ◽  
Crc Screening

Colorectal cancer (CRC) is still one of the leading causes of cancer-related death all over the world. An early diagnosis is fundamental thing for reducing the CRC-related morbidity and mortality. Nowadays researchers are studying more reliable and effective non-invasive screening tests, using easily available biological samples, such as feces. Such methods have high potential to collect and deliver samples. The comparison of some new variants genomic fecal DNA analysis and traditional fecal occult blood tests are discussed in this review. Sensitivity, specificity of the methods, processability, efficacy and ability of early CRC screening are the criteria for the preference of the using of one of these methods. These factors give the opportunity to carry out the large-scale CRC screening. This technological advance promises to increase the efficiency of the fecal DNA analysis and put the using of new clinical applications.

scholarly journals Using Comorbidity Pattern Analysis to Detect Reliable Methylated Genes in Colorectal Cancer Verified by Stool DNA Test

Genes ◽  
2021 ◽  
Vol 12 (10) ◽  
pp. 1539
Author(s):  
Yi-Chiao Cheng ◽  
Po-Hsien Wu ◽  
Yen-Ju Chen ◽  
Cing-Han Yang ◽  
Jhen-Li Huang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Dna Methylation ◽  
Integrated Approach ◽  
Normal Subjects ◽  
Screening Tests ◽  
Dna Test ◽  
Crc Screening ◽  
Epigenetic Biomarkers ◽  
Novel Approach ◽  
Genome Wide

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide in 2020. Colonoscopy and the fecal immunochemical test (FIT) are commonly used as CRC screening tests, but both types of tests possess different limitations. Recently, liquid biopsy-based DNA methylation test has become a powerful tool for cancer screening, and the detection of abnormal DNA methylation in stool specimens is considered as an effective approach for CRC screening. The aim of this study was to develop a novel approach in biomarker selection based on integrating primary biomarkers from genome-wide methylation profiles and secondary biomarkers from CRC comorbidity analytics. A total of 125 differential methylated probes (DMPs) were identified as primary biomarkers from 352 genome-wide methylation profiles. Among them, 51 biomarkers, including 48 hypermethylated DMPs and 3 hypomethylated DMPs, were considered as suitable DMP candidates for CRC screening tests. After comparing with commercial kits, three genes (ADHFE1, SDC2, and PPP2R5C) were selected as candidate epigenetic biomarkers for CRC screening tests. Methylation levels of these three biomarkers were significantly higher for patients with CRC than normal subjects. The sensitivity and specificity of integrating methylated ADHFE1, SDC2, and PPP2R5C for CRC detection achieved 84.6% and 92.3%, respectively. Through an integrated approach using genome-wide DNA methylation profiles and electronic medical records, we could design a biomarker panel that allows for early and accurate noninvasive detection of CRC using stool samples.

scholarly journals The impact of information about different absolute benefits and harms on intention to participate in colorectal cancer screening: A think-aloud study and online randomised experiment

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246991
Author(s):  
Juliet A. Usher-Smith ◽  
Katie M. Mills ◽  
Christiane Riedinger ◽  
Catherine L. Saunders ◽  
Lise M. Helsingen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Tests ◽  
Baseline Risk ◽  
Prior History ◽  
Think Aloud ◽  
Individual Level ◽  
Risk Levels ◽  
Crc Screening ◽  
History Of ◽  
The Impact

Background There is considerable heterogeneity in individuals’ risk of disease and thus the absolute benefits and harms of population-wide screening programmes. Using colorectal cancer (CRC) screening as an exemplar, we explored how people make decisions about screening when presented with information about absolute benefits and harms, and how those preferences vary with baseline risk, between screening tests and between individuals. Method We conducted two linked studies with members of the public: a think-aloud study exploring decision making in-depth and an online randomised experiment quantifying preferences. In both, participants completed a web-based survey including information about three screening tests (colonoscopy, sigmoidoscopy, and faecal immunochemical testing) and then up to nine scenarios comparing screening to no screening for three levels of baseline risk (1%, 3% and 5% over 15 years) and the three screening tests. Participants reported, after each scenario, whether they would opt for screening (yes/no). Results Of the 20 participants in the think-aloud study 13 did not consider absolute benefits or harms when making decisions concerning CRC screening. In the online experiment (n = 978), 60% expressed intention to attend at 1% risk of CRC, 70% at 3% and 77% at 5%, with no differences between screening tests. At an individual level, 535 (54.7%) would attend at all three risk levels and 178 (18.2%) at none. The 27% whose intention varied by baseline risk were more likely to be younger, without a family history of CRC, and without a prior history of screening. Conclusions Most people in our population were not influenced by the range of absolute benefits and harms associated with CRC screening presented. For an appreciable minority, however, magnitude of benefit was important.

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