Colorectal Cancer Screening Outcomes among a Sample of Low-Income, Uninsured Texans: A Program-Based Study
Introduction
Colorectal cancer (CRC) is the second-leading cause of cancer-related mortality in the United States. To increase the early detection of CRC, it is essential to encourage and facilitate regular colorectal cancer screening through fecal immunochemical testing (FIT) and colonoscopy. However, low-income individuals, residing in medically underserved and rural areas have lower rates of CRC screening uptake. Currently, there is limited research addressing the nexus of these factors on the uptake of CRC screening.
Methods
This retrospective study utilized 12 years of data from the Texas Cancer Screening, Training, Education, and Prevention Program (C-STEP) at Texas A&M Health. The study focused on individuals residing in rural and medically underserved areas (MUAs) who underwent colonoscopy and FIT procedures. Stratification based on individual and rural characteristics was performed, and the association between these factors and colorectal cancer screening outcomes was assessed using Fisher’s exact test and Chi-square test.
Results
The program has provided 3496 colonoscopies and 912 fecal immunochemical tests to participants who met eligibility criteria. For participants completing fecal immunochemical testing 2.34% tested positive. Among participants who received colonoscopy, the prevalence of abnormal outcomes was 39.32 per 100 procedures, including 28.43 per 100 procedures for precancerous lesions and 0.8 per 100 procedures for colorectal cancer. Chi-square test results indicated that Non-Hispanic White unmarried males were statistically more likely to demonstrate abnormal outcomes P < 0.05 associated with colorectal cancer colonoscopy screening. In this sample, abnormal FIT outcome data had no statistically significant associations.
Conclusion
This research reveals that race/ethnicity, age, gender, and marital status are significant predictors for both precancerous lesions and colorectal cancer for individuals completing colonoscopy screening. The occurrence of colorectal cancer in our study is higher than the occurrence rate in the United States. These findings highlight how social determinants of health-related factors, particularly among disadvantaged populations living in rural and medically underserved areas, influence the likelihood of precancerous lesions or colorectal cancer diagnosis. Future research should prioritize implementing screening and navigation strategies to reach these vulnerable populations as well as promoting colorectal cancer education and screening for early detection.