Abstract C67: Colorectal cancer screening in rural and frontier communities: The FluFIT on the Frontera Project
Authors: Hurd Thelma C. , Lozano Ceci , Sotelo Simon , Adame Samantha , Rodriguez Raquel , Guerra Hector , Sunil Thankam 
Published: March 2017

The prevalence of colorectal cancer screening among people living in Texas-Mexico, rural/frontier Border communities and colonias is not well characterized. While colorectal cancer screening in the Border region is 30%, among Hispanics, FOBT screening in the prior 2 years is 9.4%, and 59% of screening eligible adults have never had endoscopy (Texas BRFSS 2010). The FluFIT on the Frontera project, a colorectal cancer screening project for average risk people, was adapted from the evidence based FluFIT curriculum and implemented in a rural/frontier community setting to increase colorectal cancer screening. The project provides education, screening, early detection and treatment through community and regional partnerships. It targets Hispanic and underserved men and women aged 50-75 years of age who reside in the rural/frontier communities of Del Rio Texas and the surrounding colonias.

Methods Clinic based providers and certified male and female promotores from Val Verde Regional Medical Center and QUAD Counties Promotoras Program, respectively, received formal didactic and implementation training for the FluFIT intervention. Participants received colorectal cancer screening education and FluFIT test process instruction from trained staff in the clinical setting and promotores in the community setting. Clinic and community based navigators provided participant navigation to insure timely receipt of specimens for analysis and follow-up. Participants who did not have a primary care provider were assigned to a provider in the Val Verde Regional Medical Center primary care clinic. All test results were provided to participants by either their assigned or private primary care providers. An integrated clinic and community based provider, navigator and project partnership assured referral for appropriate services as needed for positive tests.

Results In the first 7 months of community programming 3743 community members were educated in either group or individual settings. Of these, 1959 adults (789 males, 40%; 1170 females) aged 50-75 years were evaluated for screening. Seventy five percent self-identified as white Hispanic and 25% as non-Hispanic. 753 met the screening eligibility criteria and 1206 did not. Of 753 (38.4%) who were screening eligible, 563 (74.8%) received FIT kits. Among 342 kits (60.7%) that were returned, 14 (12.57%) were positive. Colonoscopy was completed in 79% of patients with a positive FIT test and polyps were identified in 7. No cancers were diagnosed. Average and high risk participants accounted for 58.8% and 41.2% of people who were ineligible for screening. Among ineligible average risk participants 659 (80.3%) had prior screening. Among 575 high risk patients, 199 (34.6%) reported no prior screening. Prior screening accounted for 74.1% of participant ineligibility overall irrespective of risk stratification.

Conclusions The FluFIT intervention is being successfully implemented in a rural/frontier community. The high proportion of males recruited to this study suggests that male promotores positively impact male recruitment. Colorectal cancer screening in this rural/frontier population is higher than previously reported in BRFSS and approaches that of the Border region (30%). The increased prevalence of participants who are high risk for colorectal cancer is a surprising finding that merits further investigation to better understand the population risk.

Citation Format: Thelma C. Hurd, Ceci Lozano, Simon Sotelo, Samantha Adame, Raquel Rodriguez, Hector Guerra, Thankam Sunil. Colorectal cancer screening in rural and frontier communities: The FluFIT on the Frontera Project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C67.