A0167 - Improving Colorectal Cancer Screening to Implement New Guidelines

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Ammar Aqeel, MD

MercyHealth Internal Medicine Residency
Rockford, IL

Ammar Aqeel, MD¹, Luqman Baloch, MD¹, Mudassar K. Sandozi, DO¹, Nagesan Rajendran, MD¹, Naser Khan, MD², Altaf Dawood, MD²
¹MercyHealth Internal Medicine Residency, Rockford, IL; ²MercyHealth Gastroenterology Fellowship, Rockford, IL

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer-related deaths in the U.S. The American College of Gastroenterology recently updated their CRC screening guidelines in March 2021 to screen ages 45-75. The U.S. Preventive Services Task Force also added Grade B recommendations to screen individuals aged 45-49 as of May 2021. With these updates in mind, a quality improvement project was initiated to increase CRC screening in patients aged 45-49 years.

Methods: Our primary objective was to improve rates of CRC screening in ages 45-49. Only average risk patients aged 45-49 with no prior CRC screening were included. Patients with a personal or family history of CRC, adenomatous polyps, Lynch syndrome, familial adenomatous polyposis, & recent gastrointestinal bleed were excluded.

In June 2021, our institution’s healthcare gaps were modified to include CRC screening for ages 45-49. Patients 3 months pre-intervention were compared to those 3 months post-intervention. Baseline demographics were also assessed. The type of screening, adenoma detection rates, colonic lesion rates, & malignant neoplasm rates were evaluated as secondary outcomes.

Results: Overall demographics were similar between the two groups. Both had similar age, BMI, sex, race, & ethnicity. The amount of open healthcare gaps, use of alcohol, & tobacco use were also very similar.

We found a statistically significant improvement in CRC screening rates after the intervention. A total of 59 patients (0.0445%) completed CRC screening pre-intervention. While 131 patients (0.0989%) received CRC screening post-intervention. Our primary objective was met with a P < 0.0001. A comprehensive increase of 71 patients received CRC screening post-intervention. Secondary outcomes however revealed no significant difference between the pre & post-intervention groups.

Discussion: Our implementation did not assess other CRC screening modalities other than colonoscopy & FIT MTS-DNA stool testing as our institution predominantly uses these two methods for screening.

Despite this limitation, our project successfully achieved its goal. A total of 71 additional patients completed CRC screening. This translates to an improvement of CRC screening by over 200%. Though there was no significant difference in detecting malignant adenomatous neoplasms, this increase still theoretically translates to detection of 2 additional patients diagnosed with CRC per epidemiological studies. Overall further work needs to be done to improve our CRC screening rates.

Figure: Number of Patients Who Received Colorectal Cancer Screening by Month

Demographics & Outcomes	Pre-Intervention	Post-Intervention	P-value
Median Age	48	47
Median BMI	30.5	29.6
Male Sex Percentage	54.2%	46.9%	P = 0.53 [95% CI: -0.147 to 0.285]
Median Care Gap Score¶	3	3
Max Care Gap Score♠	7	7
Average Alcohol Use Per Week	3 / week	4 / week
Smoking Percentage♥	8%	20%	P = 0.073 [95% CI: -0.238 to 0.010]
Caucasian Race	86.4%	91.3%	P = 0.736 [95% CI: -0.343 to 0.240]
African American Race	4.7%	4.31%
Hispanic Ethnicity	0.53%	0.63%
Asian Americans and Pacific Islanders Race	0.79%	0.80%
Total Patients Eligible for CRC♣ Screening	132452	132432
Total CRC Screened Number of Patients	59	131
Total CRC Screened Percentage	0.0445%	0.0989%	P < 0.0001 [95% CI: -0.000748 to -0.000340]
CRC Screened through Colonoscopy	59	80
CRC Screened through FIT MTS-DNA	0	51
Adenoma Detection Rate on Colonoscopyº	44.1%	38.8%	P = 0.63 [95% CI: -0.162 to 0.269]
Colonic Lesion Detection Rate on Colonoscopyª	42.4%	40%	P = 0.83 [95% CI: -0.192 to 0.240]
Malignant Adenomatous Neoplasms Detection Rate on Colonoscopy	0%	0%

Table: ¶. Median number of healthcare gaps that were unresolved in patients after CRC screening took place.
♠. Maximum number of healthcare gaps that were unresolved in patients after CRC screening took place.
♥. Percentage of patients with any prior history of smoking as documented by Social History.
♣. Colorectal Cancer.
º. Percentage of patients who were found to have 1 or more precancerous polyps detected on colonoscopy.
ª. Percentage of patient who were found to have colonic lesions of any kind aside for polyps on colonoscopy.

Disclosures:

Ammar Aqeel indicated no relevant financial relationships.

Luqman Baloch indicated no relevant financial relationships.

Mudassar Sandozi indicated no relevant financial relationships.

Nagesan Rajendran indicated no relevant financial relationships.

Naser Khan indicated no relevant financial relationships.

Altaf Dawood indicated no relevant financial relationships.

Ammar Aqeel, MD¹, Luqman Baloch, MD¹, Mudassar K. Sandozi, DO¹, Nagesan Rajendran, MD¹, Naser Khan, MD², Altaf Dawood, MD². A0167 - Improving Colorectal Cancer Screening to Implement New Guidelines, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.