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Impact of ethnicity and economic status on access to colon cancer screening

Hayman A, Toto E, Pozgay DJ, Bentrem D, Brenner D. Impact of ethnicity and economic status on access to colon cancer screening. Paper presented at: American Gastroenterology Association Annual Meeting; 2011 May 10; Chicago, IL.

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Introduction: The CDC recently reported that only 63% of Americans receive appropriate colorectal cancer (CRC) screening. One barrier is the significant gap between demand for lower endoscopy and supply of endoscopists. This gap is particularly wide for patients of low socioeconomic status: fewer than 50% of Hispanics or persons with lower income, and only 36% of those without health insurance, received CRC screening. Pro bono colonoscopy programs have great potential for bridging this gap. The aims of our study were to: 1) describe the demographics of patients receiving diagnostic colonoscopies via our institution's pro bono program, 2) document the incidence of pre-cancerous and cancerous lesions in this population, and 3) determine if physician recommendations regarding subsequent endoscopic surveillance adhere to national guidelines. Methods: Our institution, a large, urban academic medical center, began a pro bono diagnostic colonoscopy program in July 2009 for patients at increased risk of colorectal cancer who were referred from local free clinics. Via retrospective chart review, we collected patient demographics (age, gender, and race), colonoscopy indication, endoscopic findings, pathology results, physician recommendation for interval endoscopic surveillance, and the appropriateness of this recommendation based on the US Preventive Services Task Force (USPSTF) guidelines. Results: 164 patients were included in this study. Our patients were predominantly female (60%) and from Hispanic (58%) or Eastern European decent (23%). Mean age at time of endoscopy was 56 years. Primary indications for colonoscopy were: positive FOBT (62%), rectal bleeding (16%), personal history of polyps (11%), family history of colon cancer (5%), or other (6%). Quality of bowel prep was good/ excellent in 80%, fair/poor in 7%, and not documented in 13%. Of the 70 (43%) patients who underwent polypectomy, 64% were adenomatous, 20% were benign, 10% were normal mucosa, and 6% were cancerous. X% of physician recommendations adhered to USPSTF guidelines. There were no periprocedural complications noted. Conclusions: In a high-risk population who would normally not receive screening or diagnostic colonoscopy, almost half of the patients were found to have pre-cancerous or cancerous lesions. Although the majority of physician recommendations for interval endoscopic surveillance were appropriate, there is still room for improvement in both procedure note documentation and knowledge regarding recommended follow up. Our study suggests that care provided to pro bono colonoscopy patients can be safe, appropriate, and potentially life-saving. This program is an example of an effective way to improve access to colorectal screening, diagnosis, and care.

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