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ENDOSCOPIC FINDINGS OF A STATE-SPONSORED COLORECTAL CANCER SCREENING PROGRAM: A CASE-MATCHED CONTROL COMPARISON STUDY
Alfonsus Adrian H. Harsono
*1, Lauren Wood
1, Raj Roy
1, Nathan C. English
2,1, Gregory Kennedy
1, Daniel I. Chu
1, Patricia Ajayi-Fox
3, Robert H. Hollis
11Department of Surgery, Div. of Gastrointestinal Surgery, The University of Alabama at Birmingham Department of Surgery, Birmingham, AL; 2University of Cape Town Department of Surgery, Cape Town, WC, South Africa; 3The University of Alabama at Birmingham Department of Medicine, Birmingham, AL
Introduction Socioeconomically vulnerable patients suffer higher colorectal cancer (CRC) incidence and mortality as they face more barriers to screening. State-sponsored screening programs were intended to improve access by removing financial barriers. This study aimed to compare the endoscopic findings of state-sponsored patients to case-matched controls.
Methods Low-income, under-insured patients were enrolled in a state-sponsored colonoscopy program from the Alabama Department of Public Health (ADPH) between 2022-2024. Patients undergoing colonoscopy with screening indication and adequate bowel preparation at a single hospital were included using data from the Gastrointestinal Quality Improvement Consortium (GIQuIC) database. Exact matching was performed with a 1:2 ratio of state-sponsored patients to non-state-sponsored controls by age, sex, and race. The primary outcome was the detection of colonoscopy abnormalities, including adenomatous polyps and advanced neoplasms or adenomas. Secondary outcomes included the quality of the colonoscopies. Bivariate analysis was performed using Chi-square or non-parametric Wilcoxon test.
Results A total of 393 patients, comprising of 131 ADPH patients and 262 non-ADPH patients were included in the study. The mean age was 56 (±6.1), 55.1% were female, and 79.4% were Black race. As shown in
Figure 1, there was no significant difference in polyp retrieval rates between the ADPH and non-ADPH groups (58.8% vs 56.1%, p=0.61). Tubular adenomas were similarly detected within both groups (40.5%). Advanced polyps/neoplasms were also detected at similar rates among the state-sponsored group compared to the control (9.2% vs. 5.3%, p=0.15). Serrated polyp findings were higher in the control group (8.4% vs. 1.5%, p=0.01), including 10 mm or greater (7.6% vs. 1.5%, p=0.013). In terms of colonoscopy quality between the two groups, there was no significant difference in withdrawal time between the two groups (10 vs. 9 min, p=0.89;
Table 1). However, procedure time is relatively longer among ADPH-sponsored patients (23 vs. 15 min, p<0.01).
Conclusion Among patients undergoing screening colonoscopy in a state-sponsored colorectal cancer screening program, similar rates of adenomatous polyps and advanced neoplasms were found compared to non-state-sponsored patients. These findings highlight the importance of state-sponsored programs for reducing CRC incidence and mortality, even among patients meeting screening colonoscopy indications.
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