Abstract B95: Barriers to completion of a free colorectal cancer screening program in a low-income population
Authors: Zahnd Whitney , Steward David , Jenkins Wiley , Andoh Jennifer , Mueller Georgia , Puczynski Sandra 
Published: May 2015

Colorectal cancer (CRC) is the fourth most common cancer in the US. Screening is effective to prevent and detect CRC, but is underutilized in underserved populations. We assessed a free CRC screening program intended for the underserved population in central Illinois to determine what factors (demographics, medical history, risk factors, perceived barriers, rurality) prevented eligible patients from completing CRC screening.

Methods: Potential participants were recruited to the Vince Demuzio Colorectal Screening Initiative via postcard mailing, media advertising and physician referral from July 2010 to June 2012. Interested participants called a toll-free number for an eligibility assessment, which required: being due for a CRC screening, age of 50-64 years, uninsured/underinsured, ≤250% of the federal poverty level, and residence in the 22 county (1 urban and 21 rural counties) catchment area. Eligible participants then completed a questionnaire via phone about their demographics, screening history, risk factors, and screening barriers, and were sent documents to sign for enrollment. Once signed documents were returned, patients chose to complete a fecal occult blood test (FOBT) or schedule a pre screening appointment and colonoscopy at 1 of 13 participating local hospitals. Analysis of 22 factors associated with screening was performed comparing residency (rural vs. urban) and screening completion (completers vs. non-completers) using Fisher's exact tests and independent t-tests.

Results: There were 352 eligible participants, and they were: 86 % white, 57% female, 90% with at least a high school education, 60 % rural and 37 % current smokers. 245 participants (69.6%) completed CRC screenings (233 colonoscopies and 12 FOBTs). Ultimately, 107 (30.4%) eligible individuals did not complete screening due to the following: unreturned enrollment documents (54), loss to follow-up or withdrawal (44), did not return FOBT card (4) or were later deemed ineligible (5). Overall, rural participants were more likely than urban to be female (66.2% vs.44.4%, p&lt;0.001), white (98.6% vs.68.3%, p&lt;0.001), to have had a past blood stool test (25.8% vs. 9.4%, p=0.013) and to have a history of polyps (12.9% vs. 4.9%, p=0.016). Screening completion rates did not differ between urban and rural participants (65.5 % vs. 72.4%, p=0.19). The only factor significantly different between completers (C) and non-completers (NC) was report of a past blood stool test (42.4% vs. 29.9%, p=0.03), and among those reporting a past test, having a test within the past year (23.1% vs. 7.5%; p=0.04). Rural NC were more likely to note fear of discomfort as a barrier than urban NC (28.6% vs. 10.6%; p=0.03). There were no other significant differences at these stratifications.

Conclusions: Despite meeting eligibility criteria, roughly a third of interested patients did not receive CRC screening. Rural NC differed from urban NC. Rural NC were more often female, white (anticipated in rural Illinois) and reported procedure discomfort as a screening barrier. However, most examined patient-related factors did not differ between groups and stratifications. Patient anecdotes indicated that more efficient processes, such as reduction in enrollment and screening steps and assistance with scheduling, may improve completion rates. Also, efforts should be made to both address gender and race differences that might impact screening in rural populations and develop better survey tools to identify screening barriers.

Citation Format: Whitney Zahnd, David Steward, Wiley Jenkins, Jennifer Andoh, Georgia Mueller, Sandra Puczynski. Barriers to completion of a free colorectal cancer screening program in a low-income population. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B95. doi:10.1158/1538-7755.DISP13-B95