Results from a systematic review, which explores predictors of adherence among average risk adults across three decades to understand how the factors driving adherence differ over time and by specific care setting, were presented at the American Society of Preventive Oncology (ASPO) annual meeting, held March 13-15, 2022 in the Tucson Marriott University Park in Tucson, Arizona.

Colorectal Cancer (CRC) screening reduces the mortality caused by CRC. [1] and occurs in a wide variety of care settings.[2] While only about two-thirds of those age >50 years are up to date on CRC screening,[3] certain populations have even lower rates, including people ages 50-54 years (48%), those of Hispanic ethnicity (59%) and Medicaid recipients (53%).[4]

The PREEMPT CRC study, sponsored by Freenome, a San Francisco based biotechnology company, is a prospective multi-center observational study to validate a blood-based test for the early detection of colorectal cancer by collecting blood samples from average-risk participants who will undergo a routine screening colonoscopy.

The the ongoing study, which includes more than 30,000 participants, is the largest prospective study to date for a noninvasive CRC screening in an average-risk population, examined the frequency of more than 100 predictors of adherence organized by type of factor (e.g., test, patient, provider, site and environment) across five study settings, including primary care, specialty care, integrated system, safety net (e.g., community health centers) and regional cross-sectional surveys.

Across these settings, the study found 71.1% of predictors were patient-related factors, primarily demographics (e.g., age, ethnicity, and sex) and perceived importance of screening. The proportion of each predictor varied by care setting, but across all studies patient environment factors (e.g., local federal poverty level and proximity to healthcare facilities) doubled and clinic site factors (e.g., screening programs and appointment duration) tripled in the last five years.

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“This research emphasizes the need for taking a more holistic view of cancer screening,” said Caitlin C. Murphy, PhD, MPH and coauthor of the study.

“We need to look beyond the patient to recognize and address other factors like the patient’s neighborhood and clinic site that impact adherence,” Murphy added.

Patient preferences
In addition to continued support for programmatic screening, recent studies advocated for incorporating patient preferences and culturally-competent materials to increase adherence.

“Adherence is so fundamentally tied to health equity, which is a driving force behind the work we do every day,” said Mike Nolan, chief executive officer at Freenome.

“This research underscores the importance of understanding and addressing the socioeconomic factors that affect CRC screening adherence, so we can save more lives.” explained Nolan.

Clinical trials
Prevention of Colorectal Cancer Through Multiomics Blood Testing (PREEMPT CRC) – NCT04369053

[1] Zauber AG. The impact of screening on colorectal cancer mortality and incidence: has it really made a difference? Dig Dis Sci. 2015 Mar;60(3):681-91. doi: 10.1007/s10620-015-3600-5. Epub 2015 Mar 5. PMID: 25740556; PMCID: PMC4412262.
[2] Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021 May 18;325(19):1978-1998. doi: 10.1001/jama.2021.4417. Erratum in: JAMA. 2021 Jul 20;326(3):279. PMID: 34003220.
[1] Joseph DA, King JB, Richards TB, Thomas CC, Richardson LC. Use of Colorectal Cancer Screening Tests by State. Prev Chronic Dis. 2018 Jun 14;15:E80. doi: 10.5888/pcd15.170535. PMID: 29908051; PMCID: PMC6016405.
[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30. doi: 10.3322/caac.21590. Epub 2020 Jan 8. PMID: 31912902.

Featured image: Microscopy of human colorectal cancer cells. DNA is labelled red. Photo courtesy: Regmi S., Dasso M., NICHD/NIH. Used with permission.

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