Abstract A112: A longitudinal evaluation of repeat colorectal cancer screening in a Federally Qualified Health Center (FQHC)
Authors: Nonzee Narissa J. , Glenn Beth A. , Rosen Debra , Herrmann Alison K. , May Folasade P. , Chang L. Cindy , Crespi Catherine , Lwin Alicia , Park Christine , Avila Analissa , Bastani Roshan 
Published: January 2023

Background: Colorectal cancer (CRC) can be detected early or prevented through screening at recommended intervals. Fecal immunochemical testing (FIT), an inexpensive stool-based screening test, is the primary screening modality in low-resource health care settings, including Federally Qualified Health Centers (FQHCs). However, to maximize its life saving benefit, FIT screening must be completed annually (repeat screening), per guidelines. In FQHCs, only about 40% of eligible patients are up-to-date on CRC screening at a given time. Less is known about completion of repeat FIT over time in this setting. Therefore, UCLA partnered with Northeast Valley Health Corporation (NEVHC), a large multi-site FQHC serving predominantly low-income Latinos, to assess repeat FIT rates and factors that contribute to repeat FIT over a 5-year follow-up period. Methods: We performed a retrospective cohort study among NEVHC patients who completed a FIT test in 2013 and examined CRC screening completion over the subsequent 5 years (2014-2018). The study was conducted in eight comprehensive primary care sites at NEVHC. Our cohort included patients ages 50-70 years with a normal index FIT in 2013 and who were active NEVHC patients during the subsequent 5-year follow-up period. Using electronic medical record and administrative data, we identified that only one patient completed five rounds of screening at yearly intervals, as recommended, and thus calculated “repeat FIT” rate as the proportion of patients who completed at least 3 total FIT tests or a colonoscopy (i.e., index FIT and 2 additional FIT tests or colonoscopy) over the 6-year study period (2013-2018). We also performed bivariate analyses to evaluate factors associated with repeat FIT completion. Results: Among the 771 patients included in our sample, the average age at index FIT was 57 years. The majority of patients were Latino (83%, n=638) and spoke Spanish as their primary language (76%, n=588), and 43% (n=330) were insured through Medicaid, Medicare, California’s state health insurance exchange, or other private insurance. Overall, 61% (n=471) of our sample completed at least 3 total FIT tests or colonoscopy over the 6-year study period. There were significant differences in repeat FIT rates across the eight primary care clinics, ranging from 34% to 72%; the highest volume clinic had the highest repeat FIT rate. Significantly higher rates of repeat FIT were also observed among patients with frequent encounters and who were Latino vs. non-Latino (65% vs. 42%), Spanish-speaking vs. not (68% vs. 40%), uninsured or self-pay vs. publicly or privately insured (70% vs. 49%); all p&lt;0.05.Conclusions. Findings suggest significant patient and clinic variation in completion of repeat FIT testing among active patients engaged in care. These results support the need for interventions to improve recurrent, guideline-concordant FIT screening in low-resource clinical settings that deliver essential cancer screenings to medically underserved populations.

Citation Format: Narissa J. Nonzee, Beth A. Glenn, Debra Rosen, Alison K. Herrmann, Folasade P. May, L. Cindy Chang, Catherine Crespi, Alicia Lwin, Christine Park, Analissa Avila, Roshan Bastani. A longitudinal evaluation of repeat colorectal cancer screening in a Federally Qualified Health Center (FQHC) [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A112.