Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina

This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50–64 years (45–64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45–49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites. 1. Introduction There is wide variation across population subgroups in cancer incidence, mortality, or both. Nationally in the United States of America, African Americans (AAs) have ≈17% higher colorectal cancer (CRC) incidence and ≈47% higher mortality than Whites [1]. AAs also are diagnosed at younger ages, on average and with later-stage disease, have a higher incidence before the recommended screening age of 50 years, and tend to have worse prognoses even after accounting for other factors [2, 3]. These disparities tend to be much larger in South Carolina (SC) than in the US average [4, 5]. The majority of CRCs in average-risk individuals arise from the polyp-to-cancer pathway, which translates into an opportunity to prevent cancers by removing polyps detected through screening age-appropriate adults. Of all cancer screening tests, colonoscopy is the most effective both for early detection and, more importantly, for primary prevention of CRC because it enables removal of precancerous polyps before they turn cancerous. Colonoscopy has some disadvantages, however. It requires specially trained physicians and is expensive and invasive, requiring a well-equipped and well-staffed facility for safe, high-quality performance. Consequently, health insurance