Recommendation of colorectal cancer testing among primary care patients younger than 50 with elevated risk

• Published in: Preventive medicine 2017-09, Vol.102, p.20-23
• Main Authors: Skinner, Celette Sugg, Ahn, Chul, Halm, Ethan A, Bishop, Wendy Pechero, McCallister, Katharine, Sanders, Joanne M, Farrell, David, Santini, Noel, Singal, Amit G
• Format: Article
• Language: English
• Subjects: Adult; Black or African American; Black People - statistics & numerical data; Cancer screening; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - prevention & control; Decision support; Early Detection of Cancer - methods; Female; Hispanic or Latino - statistics & numerical data; Humans; Internal Medicine; Male; Mass Screening; Medical History Taking; Middle Aged; Primary Health Care; Risk Factors; Tailored interventions; White People - statistics & numerical data
• ISSN: 0091-7435; 1096-0260; 1096-0260
• DOI: 10.1016/j.ypmed.2017.06.014

Abstract In the era of precision medicine, efforts are needed to identify and tailor screening recommendations among elevated-risk patients. Individuals younger than 50 years are an important target population, as they comprise 15% of colorectal (CRC) cases and often present with more advanced disease than their 50 + counterparts. In this large study, 2470 patients ages 25–49 used a tablet-based program that assessed risks, matched risks with screening guidelines, and generated tailored printed guideline-concordant recommendations for patients and their providers. The tablet-based program identified 121 (4.9%) patients with risk factors warranting screening before age 50. Likelihood of risk warranting screening was greater for ages 40–49 than < 40 years (OR: 2.38), females than males (OR: 1.82), and African Americans (OR: 1.69) and non-Hispanic Whites (OR: 2.89) compared to Hispanics. Most common risk factors were family history of polyps (23.1%), personal history of inflammatory bowel disease (19.8%), and combined family history of CRC + polyps (18.2%). Receipt of guideline-concordant screening within 6 months of identification was low, including only 5.3% of those who needed colonoscopy and 13.3% for whom colonoscopy or FIT was recommended. Although elevated-risk patients younger than 50 years can be readily identified, more than notification is necessary to facilitate screening participation.