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• W2003032015 abstract "Background & Aims: Although colonoscopy is becoming the preferred screening test for colorectal cancer, screening rates, particularly among minorities, are low. Little is known about the uptake of screening colonoscopy or the factors that predict colonoscopy completion among minorities. This study investigated the use of patient navigation within an open-access referral system and its effects on colonoscopy completion rates among urban minorities. Methods: This was a cohort study that took place at a teaching hospital in New York. Participants were mostly African Americans and Hispanics directly referred for screening colonoscopy by primary care clinics from November 2003 to May 2006. Once referred, a bilingual Hispanic female patient navigator facilitated the colonoscopy completion. Completion rates, demographic factors associated with completing colonoscopy, endoscopic findings, and patient satisfaction were analyzed. Results: Of 1169 referrals, 688 patients qualified for and 532 underwent navigation. Two thirds (66%) of navigated patients completed screening colonoscopies, 16% had adenomas, and only 5% had inadequate bowel preps. Women were 1.31 times more likely to complete the colonoscopy than men (P = .014). Hispanics were 1.67 times more likely to complete the colonoscopy than African Americans (P = .013). Hispanic women were 1.50 times more likely to complete the colonoscopy than Hispanic men (P = .009). Patient satisfaction was 98% overall, with 66% reporting that they definitely or probably would not have completed their colonoscopy without navigation. Conclusions: By using a patient navigator, the majority of urban minorities successfully completed their colonoscopies, clinically significant pathology was detected, and patient satisfaction was enhanced. This approach may help increase adherence with screening colonoscopy efforts in other clinical settings. Background & Aims: Although colonoscopy is becoming the preferred screening test for colorectal cancer, screening rates, particularly among minorities, are low. Little is known about the uptake of screening colonoscopy or the factors that predict colonoscopy completion among minorities. This study investigated the use of patient navigation within an open-access referral system and its effects on colonoscopy completion rates among urban minorities. Methods: This was a cohort study that took place at a teaching hospital in New York. Participants were mostly African Americans and Hispanics directly referred for screening colonoscopy by primary care clinics from November 2003 to May 2006. Once referred, a bilingual Hispanic female patient navigator facilitated the colonoscopy completion. Completion rates, demographic factors associated with completing colonoscopy, endoscopic findings, and patient satisfaction were analyzed. Results: Of 1169 referrals, 688 patients qualified for and 532 underwent navigation. Two thirds (66%) of navigated patients completed screening colonoscopies, 16% had adenomas, and only 5% had inadequate bowel preps. Women were 1.31 times more likely to complete the colonoscopy than men (P = .014). Hispanics were 1.67 times more likely to complete the colonoscopy than African Americans (P = .013). Hispanic women were 1.50 times more likely to complete the colonoscopy than Hispanic men (P = .009). Patient satisfaction was 98% overall, with 66% reporting that they definitely or probably would not have completed their colonoscopy without navigation. Conclusions: By using a patient navigator, the majority of urban minorities successfully completed their colonoscopies, clinically significant pathology was detected, and patient satisfaction was enhanced. This approach may help increase adherence with screening colonoscopy efforts in other clinical settings. See Editorial on page 377.Screening for colorectal cancer (CRC) is highly effective for reducing cancer-associated mortality and therefore is endorsed by all major medical societies.1Levin B. Barthel J.S. Burt R.W. et al.Colorectal cancer screening clinical practice guidelines.J Natl Compr Canc Netw. 2006; 4: 384-420PubMed Google Scholar, 2Winawer S. Fletcher R. Rex D. et al.Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence.Gastroenterology. 2003; 124: 544-560Abstract Full Text PDF PubMed Scopus (1972) Google Scholar, 3Rex D.K. ACG Board of TrusteesAmerican College of Gastroenterology action plan for colorectal cancer prevention.Am J Gastroenterol. 2004; 99: 574-577Crossref PubMed Scopus (22) Google Scholar, 4U.S. Preventive Services Task ForceScreening for colorectal cancer: recommendation and rationale.Ann Intern Med. 2002; 137: 129-131Crossref PubMed Scopus (550) Google Scholar Unfortunately, CRC screening lags significantly behind other types of cancer screenings.5Behavioral risk factor surveillance system Center for Disease Control.http://www.cdc.gov/brfssGoogle Scholar, 6American Cancer SocietyCancer facts & figures for Hispanics/Latinos 2003–2005; Page 9.http://www.cancer.org/downloads/STT/CAFF2003HispPWSecured.pdfGoogle Scholar, 7Molina L. Carlos R.C. Mark F.A. et al.Completion of colorectal cancer screening in women attending screening mammography.Acad Radiol. 2004; 11: 1237-1241Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The Behavioral Risk Factor Surveillance System showed that in 2006 only 57% of adults 50 years or older ever had a CRC screening endoscopy (flexible sigmoidoscopy or colonoscopy), and only 24% had a fecal occult blood test within the past 2 years.5Behavioral risk factor surveillance system Center for Disease Control.http://www.cdc.gov/brfssGoogle Scholar Among minorities, CRC screening rates are even lower.5Behavioral risk factor surveillance system Center for Disease Control.http://www.cdc.gov/brfssGoogle Scholar, 6American Cancer SocietyCancer facts & figures for Hispanics/Latinos 2003–2005; Page 9.http://www.cancer.org/downloads/STT/CAFF2003HispPWSecured.pdfGoogle Scholar, 8Wee C.C. McCarthy E.P. Phillips R.S. Factors associated with colon cancer screening: the role of patient factors and physician counseling.Prev Med. 2005; 41: 23-29Crossref PubMed Scopus (249) Google Scholar Although 59% of the caucasian population has had a CRC screening endoscopy, this rate is 54% for African American and only 47% for Hispanics.5Behavioral risk factor surveillance system Center for Disease Control.http://www.cdc.gov/brfssGoogle Scholar Lower CRC screening rates among minorities correlate with increased likelihood of advanced-stage presentation and higher mortality.9U.S. Cancer Statistics Working GroupUnited States cancer statistics: 2002 incidence and mortality web-based report version Centers for Disease Control and Prevention, and National Cancer Institute, 2005.http://www.cdc.gov/cancer/npcr/uscsGoogle Scholar, 10Stefanidis D. Pollock B.H. Miranda J. et al.Colorectal cancer in Hispanics: a population at risk for earlier onset, advanced disease, and decreased survival.Am J Clin Oncol. 2006; 29: 123-126Crossref PubMed Scopus (43) Google ScholarColonoscopy has been endorsed as the preferred CRC screening test by some authoritative groups, specifically the American College of Gastroenterology,3Rex D.K. ACG Board of TrusteesAmerican College of Gastroenterology action plan for colorectal cancer prevention.Am J Gastroenterol. 2004; 99: 574-577Crossref PubMed Scopus (22) Google Scholar, 11Rex D.K. Johnson D.A. Lieberman D.A. et al.Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology.Am J Gastroenterol. 2000; 95: 868-877PubMed Google Scholar and the New York City Department of Health and Mental Hygiene.12Feldman G.E. McCord C.W. Frieden T.R. Preventing colorectal cancer.City Health Information. 2003; 22: 1-4Google Scholar This is because the prevalence of colorectal polyps is quite common in persons older than age 50, and colonoscopy is both diagnostic and therapeutic. However, given the lower CRC screening rates among minorities, it is not clear what their acceptance or use of screening colonoscopy (SC) will be. Lower screening rates in minorities have been attributed to health care barriers such as lower income and education levels, inadequate or no health insurance, and difficulties with the English language.13Meissner H.I. Breen N. Klabunde C.N. et al.Patterns of colorectal cancer screening uptake among men and women in the United States.Cancer Epidemiol Biomarkers Prev. 2006; 15: 389-394Crossref PubMed Scopus (478) Google Scholar, 14Goodman M.J. Ogdie A. Kanamori M.J. et al.Barriers and facilitators of colorectal cancer screening among Mid-Atlantic Latinos: focus group findings.Ethn Dis. 2006; 16: 255-261PubMed Google Scholar, 15Thorpe L.E. Mostashari F. Hajat A. et al.Colon cancer screening practices in New York City, 2003: results of a large random-digit dialed telephone survey.Cancer. 2005; 104: 1075-1082Crossref PubMed Scopus (40) Google Scholar, 16Denberg T.D. Melhado T.V. Coombes J.M. et al.Predictors of nonadherence to screening colonoscopy.J Gen Intern Med. 2005; 20: 989-995Crossref PubMed Scopus (217) Google Scholar, 17O’Malley A.S. Forrest C.B. Feng S. et al.Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.Arch Intern Med. 2005; 165: 2129-2135Crossref PubMed Scopus (124) Google Scholar There also are substantial organizational barriers. To minimize the impact of organizational barriers, some centers have implemented direct-referral, or open-access endoscopy (OAE) systems, whereby primary care providers can refer patients directly for endoscopy, bypassing an initial evaluation by a gastroenterologist.18Eisen G.M. Baron T.H. Dominitz J.A. et al.Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy Open access endoscopy.Gastrointest Endosc. 2002; 56: 793-795Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar This decreases the number of appointments a patient must complete before obtaining an SC and shortens the time to SC. If referring physicians are educated properly on appropriate endoscopy referrals, open access can increase the number of SCs and enhance neoplasm detection.19Morini S. Hassan C. Meucci G. et al.Diagnostic yield of open access colonoscopy according to appropriateness.Gastrointest Endosc. 2001; 54: 175-179Abstract Full Text Full Text PDF PubMed Scopus (93) Google ScholarTo further increase screening rates, the concept of patient navigation has been considered. A patient navigator (PN) is someone trained to guide patients through the health care system to receive appropriate services. PNs typically provide patient education, assist with scheduling appointments, provide appointment reminders, assist with transportation needs, and they follow up with patients after the procedure to determine the need for further action. Patient navigation was developed initially to help patients with an abnormal screening test receive appropriate treatment services.20Freeman H.P. Patient navigation: a community based strategy to reduce cancer disparities.J Urban Health. 2006; 83: 139-141Crossref PubMed Scopus (173) Google Scholar Only recently has the PN concept been applied to get patients in for screening. Most research so far has focused on breast and prostate cancer screening, showing that PNs increase the rate of patient completion of screening and follow-up evaluation.20Freeman H.P. Patient navigation: a community based strategy to reduce cancer disparities.J Urban Health. 2006; 83: 139-141Crossref PubMed Scopus (173) Google Scholar, 21Tingen M.S. Weinrich S.P. Heydt D.D. et al.Perceived benefits: a predictor of participation in prostate cancer screening.Cancer Nurs. 1998; 21: 349-357Crossref PubMed Scopus (65) Google Scholar, 22Frelix G.D. Rosenblatt R. Solomon M. et al.Breast cancer screening in underserved women in the Bronx.J Natl Med Assoc. 1999; 91: 195-200PubMed Google Scholar, 23Freeman H.P. Muth B.J. Kerner J.F. Expanding access to cancer screening and clinical follow-up among the medically underserved.Cancer Pract. 1995; 3: 19-30PubMed Google Scholar, 24Battaglia T.A. Roloff K. Posner M.A. et al.Improving follow-up to abnormal breast cancer screening in an urban population: a patient navigation intervention.Cancer. 2007; 109: 359-367Crossref PubMed Scopus (204) Google Scholar In a pilot study, we reported that a PN increased the completion of fecal occult blood tests and flexible sigmoidoscopy among urban minority patients.25Jandorf L. Gutierrez Y. Lopez J. et al.Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic.J Urban Health. 2005; 82: 216-224Crossref PubMed Scopus (181) Google ScholarColonoscopy, however, is a more complex intervention, entailing a better understanding of the procedure, a complete bowel preparation, conscious sedation, work absenteeism, the need for a patient escort, and other logistical hurdles. To enhance SC rates among the predominantly minority population in our community, we designed systems in our primary care clinics to minimize screening barriers. In 2003, we instituted an open-access colonoscopy referral system to facilitate referrals from primary care physicians (PCPs). Shortly thereafter, a PN was hired to help patients complete their recommended SC. Our underlying hypothesis was that a PN significantly would enhance the successful completion of SCs among our patient population. To better determine the effect of the PN, we controlled for other potential health care barriers by enrolling patients who had health insurance (ie, Medicaid), and by hiring a bilingual English-Spanish navigator.MethodsOpen-Access EndoscopyIn November 2003, we established an OAE system for outpatients undergoing care at The Mount Sinai Hospital who were eligible for an SC. Eligibility criteria included the following: (1) physician referral from one of our primary care clinics (Internal Medicine Associates, Medicine/Pediatrics, Obstetrics/Gynecology) and (2) patient agreement to schedule their colonoscopy at our center. All providers at these clinics were educated about the open-access system and were given a standard form for referring patients at average risk for colonic neoplasia (asymptomatic, age ≥50 y, and no history of inflammatory bowel disease or CRC). Patients with significant comorbidities or gastrointestinal signs and symptoms were referred directly to the Gastrointestinal Clinic and excluded from OAE. Providers were asked to give information about past medical history, medications, and whether patients were taking aspirin, nonsteroidal anti-inflammatory medications, or anticoagulants. These forms were faxed to a single endoscopy coordinator and then reviewed by 1 of 2 gastroenterologists (J.C., S.I.). If the patient was considered a candidate for OAE, the gastroenterologist selected a bowel preparation and then forwarded the information to the PN to begin the scheduling process. Inappropriate referrals or referrals lacking essential information were returned to the referring physician.Patient NavigationA female, bilingual health educator (A.C.) was hired as the PN in April 2004. She was trained on all issues related to OAE, CRC screening, and the navigation process, including patient education, SC procedures, bowel preparation, scheduling appointments, assisting with transportation and escorts, and providing counseling and support to patients as needed. On receiving the referral form from the gastroenterologist, she contacted the patient by phone and reviewed their medical and surgical history, gathered a complete list of medications, and confirmed their insurance status. Uninsured patients were offered an SC through a parallel program at our medical center funded by the New York City Council partnered with the American Cancer Society.26New York City Department and Mental HygieneTake Care New York, Third Year Progress Report, August 2007, page 16.http://www.nyc.gov.html/doh/downloads/pdf/tcny-report-2007.pdfGoogle Scholar The PN educated patients about the details of the procedure, answered their basic questions, and scheduled their SC. This phone call was followed immediately by mailed instructions for their bowel preparation and procedure date. A reminder postcard then was mailed, informing patients of the time and location of their appointment and introducing them, by means of a composite photograph, to the panel of gastroenterologists who participate in the program. The PN contacted patients again, both 2 weeks and 3 days before the procedure, to remind them of their appointments, to confirm they had received the mailed information, and to provide education and support. If this day fell on a weekend, the call was placed on the prior Friday. If necessary, the PN also made transportation arrangements for patients. The PN explained in detail what would happen on the day of the procedure, from the time of registration until discharge. If she sensed any trepidation by the patient during the navigation process, in many instances the PN personally would meet the patient immediately before the procedure to help allay fears. Two weeks after the procedure the PN called the patients and conducted a satisfaction survey after obtaining verbal and Health Insurance Portability and Accountability Act consents.Screening ColonoscopiesColonoscopies were performed by board-certified faculty gastroenterologists (comprising a mix of sexes and ethnicities). Patients received either oral sodium phosphate or polyethylene glycol–based electrolyte solution for bowel preparation. Conscious sedation consisted of intravenous midazolam and/or meperidine administered by the endoscopist. The quality of bowel preparation was recorded by the endoscopist.Statistical AnalysesAfter institutional review board approval, we created a database of each patient’s sex, age, ethnicity, date of referral, date of arrival to navigation, and date first contacted by the PN. We also recorded the date and number of each referral and the referral status of each patient. Data were collected from referral forms, medical records, colonoscopy reports, and information was obtained from the patients by telephone.Patient data were analyzed using SPSS (version 14.0 Software for Windows; SPSS Inc, Chicago, IL). Descriptive statistics were used to tabulate the demographic characteristics of the study population. Comparisons of the mean age between completers and noncompleters were calculated by analysis of variance. Based on the demographics of the referred patients, ethnicity was divided into 3 groups: African American, Hispanic, or other (Caucasians, Asians, and others). Chi-squared tests were used to compare completion rates by sex and ethnicity. Based on the results of the univariate analyses, a logistic multivariable regression analysis was performed to determine if sex was a significant predictor within each ethnicity.Although the PN system was designed for average-risk SC referrals, some of the navigated patients were later discovered to have a positive family or personal history of CRC or polyps, or a clinical indication for CRC screening that was known at the time of referral (n = 49). These patients were categorized as having clinical indications for screening. Although these patients may have been referred incorrectly as average risk, they reflect a small percentage of patients who likely will be recommended for OAE in real-life practice and therefore were included in our calculations. A second set of analyses was performed to determine if these clinical indications predicted higher completion rates.ResultsPatient SelectionA total of 1169 referrals for Medicaid patients were made into the OAE system between November 2003 and May 2006 (Figure 1). We excluded 264 either because they required a Gastrointestinal Clinic visit for prescreening evaluation (n = 208), or because they had been referred before the onset of the PN program in April 2004 (n = 56). Thus, 905 referrals qualified for the navigated, open-access system. Of these, 44 patients were excluded who claimed to have had a screening already when first called by the PN. Multiple referrals and referrals made after at least one colonoscopy completion (n = 149) were removed so that only the most recent referral up to the point of completion was used in the final analysis. Those who, at the time of analysis, had not yet been contacted by the navigator (n = 21) or were scheduled for a colonoscopy at a future date (n = 3) were excluded, leaving 688 eligible patients who formed the basis of the present study.Among those eligible, 156 (23%) could not be navigated, and therefore did not complete their colonoscopy and were not included in the present study. The reasons for inability to navigate are listed in Figure 1. Patients found to have a gastrointestinal condition requiring evaluation in the Gastrointestinal Clinic, or those who already made an appointment with the Gastrointestinal Clinic, were referred to their PCP for further direction. A common problem was difficulty contacting patients. If a patient’s phone number was incorrect or disconnected, if they no longer had phone access, or if a message could not be left for them, up to 6 attempts were made to recontact them or to find the correct or an alternative phone number. If patients still could not be reached, the referral forms were returned to the PCP. If patients were out of the country temporarily, attempts to re-establish contact were made based on their estimated return dates. If they could not be contacted after that time, they also were referred back to their physician.The analyzed population consisted of 532 patients referred by their physician for SC via OAE who were navigated successfully. The race/ethnicity of the navigated population is presented in Table 1. The demographics of our patients closely reflect that of the overall East Harlem community of Manhattan. The vast majority are ethnic minorities, with more Hispanics than African Americans. The navigated group did not differ from the nonnavigated group with respect to mean age (Table 2). Women, however, were more likely to undergo navigation than men (P = .013), and Hispanics were the most likely to undergo navigation (P = .031).Table 1Comparison of Navigated Patients With East Harlem PopulationNavigated patients (n = 532)East Harlem year 2000 (n = 108,100)aData from http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-303.pdf.37Hispanic55% (295)55%African American31% (164)33%Other14% (73)12%a Data from http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-303.pdf.37New York City Department of Health and Mental HygieneCommunity health profiles Second edition 2006, page 2.http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-303.pdfGoogle Scholar Open table in a new tab Table 2Demographics of Navigated and Nonnavigated PatientsNavigated (n = 532)Nonnavigated (n = 156)P valueMean age, y ± SD56.3 ± 5.457.3 ± 6.9NSaAnalysis of variance test.Sex, n Female421 (79%)108 (69%).013bComparison of sexes between completers and noncompleters (χ2 = 6.66). Male111 (21%)48 (31%)Ethnicity, n Hispanic295 (55%)78 (50%).031cComparison across ethnicities between completers and noncompleters (χ2 = 6.92). African American164 (31%)43 (28%) Other73 (14%)35 (22%)a Analysis of variance test.b Comparison of sexes between completers and noncompleters (χ2 = 6.66).c Comparison across ethnicities between completers and noncompleters (χ2 = 6.92). Open table in a new tab Patients Who Completed Screening ColonoscopyAmong the 532 navigated patients, 353 (66%) completed their SCs, whereas 179 (34%) did not. Reasons for noncompletion included patients who wanted to speak in detail with their physician before the procedure (n = 14), or those who refused to undergo the procedure or navigation (n = 52). Although there was no time limit for completion, referrals for patients who did not return up to 6 messages (n = 47), rescheduled their colonoscopy appointments more than 4 times (n = 14), or did not show up for scheduled colonoscopies 2 times consecutively (n = 52) were referred back to their PCP. Thus, the no-show rate was 52 of 532 (9.8%).The demographics of completers and noncompleters are compared in Table 3. Completion of SC was not related to age. Among the completers, 291 (82%) were female (P = .01). Women were 1.31 times more likely to complete than men (95% confidence interval, 1.11–2.63; P = .014). Among completers, 211 (60%) were Hispanic, and 98 (28%) were African American (P = .019). Hispanic patients were 1.67 times more likely to complete than African Americans (95% confidence interval, 1.11–2.50; P = .013). Twenty-eight completers (8%) and 21 (12%) noncompleters had clinical indications for CRC screening or surveillance. The difference in completion rates between those with and without clinical indications was not statistically significant. Multivariable regression analysis identified Hispanic women as being 1.5 times more likely to complete an SC than Hispanic men (95% confidence interval, 1.23–4.21, P = .009). There was no difference in completion rates among African Americans by sex.Table 3Demographics of Completers and NoncompletersCompleters (n = 353)Noncompleters (n = 179)P valueMean age, y ± SD56.1 ± 5.356.7 ± 5.6NSaAnalysis of variance test.Sex, n Female291 (82%)130 (73%).01bComparison of sexes between completers and noncompleters (χ2 = 6.923). Male62 (18%)49 (27%)Ethnicity, n Hispanic211 (60%)84 (47%).019cComparison across ethnicities between completers and noncompleters (χ2 = 7.94). African American98 (28%)66 (37%) Other44 (12%)29 (16%)Clinical indication/family history, n28 (8%)21 (12%)NSaAnalysis of variance test.a Analysis of variance test.b Comparison of sexes between completers and noncompleters (χ2 = 6.923).c Comparison across ethnicities between completers and noncompleters (χ2 = 7.94). Open table in a new tab Findings at Screening Colonoscopy Among CompletersBowel preparation information was available on 330 completers, and was rated as excellent in 9%, very good in 34%, good in 48%, fair in 4%, and inadequate in only 5% of patients. Before the implementation of PN and OAE, our rate of inadequate bowel preparation historically was 12%. Colonoscopy findings are summarized in Table 4. Overall, 34.3% (n = 121) of patients had a polyp or mass that was removed by biopsy forcepts or by snare polypectomy. Approximately 16% of patients had adenomatous polyps, and 11% had hyperplastic polyps. The mean age of patients with a hyperplastic polyp (55.3 ± 5.3 y) was no different than those with a tubular adenoma (56.8 + 5.1 y) (data not shown). There was a trend for adenoma prevalence to be higher in Hispanics than in other ethnic groups (P = .056).Table 4Colonoscopy FindingsTotal patients (n = 353)Females (n = 291)Males (n = 62)African Americans (n = 98)Hispanics (n = 211)Other (n = 44)Patients with polyps, n121 (34%)93 (32%)28 (46%)34 (35%)71 (34%)16 (36%)Type of polyp Adenomatous58 (16.4%)44 (15.1%)14 (22.5%)12 (12.2%)41 (19.4%)5 (11.4%) Hyperplastic40 (11.3%)30 (10.3%)10 (16.1%)12 (12.2%)22 (10.4%)6 (13.6%) Other polyps23 (6.5%)19 (6.5%)4 (6.4%)10 (10.2%)8 (3.8%)5 (11.4%)Polyp location Distal only72 (20.3%)58 (19.9%)17 (27.4%)23 (23.5%)43 (20.4%)9 (20.4%) Proximal only31 (8.8%)27 (9.3%)4 (6.5%)10 (10.2%)16 (7.6%)5 (11.4%) Proximal and distal18 (5.1%)11 (3.8%)7 (11.3%)3 (3.1%)12 (5.7%)3 (6.8%)Adenoma multiplicity 1 adenoma27 (7.6%)21 (7.2%)6 (9.7%)6 (6.1%)19 (9.0%)2 (4.5%) >1 adenoma31 (8.8%)23 (7.9%)8 (12.9%)6 (6.1%)22 (10.4%)3 (6.8%)Adenoma histology Tubular51 (14.4%)38 (13.1%)13 (21.0%)11 (11.2%)36 (17.1%)4 (9.1%) Tubulovillous6 (1.7%)5 (1.7%)1 (1.6%)1 (1.0%)4 (1.9%)1 (2.3%) Villous1 (0.3%)1 (0.3%)001 (0.5%)0Adenoma dysplasia Low grade55 (15.6%)41 (14.1%)14 (22.6%)12 (12.2%)38 (18.0%)5 (11.4%) High grade1 (0.3%)1 (0.3%)001 (0.5%)0 Cancer2 (0.6%)2 (0.6%)002 (0.9%)0Adenoma size, mm ≤542 (11.9%)32 (11.0%)10 (16.1%)6 (6.1%)32 (15.1%)4 (9.1%) 6–99 (2.5%)6 (2.1%)3 (4.8%)4 (4.1%)5 (2.4%)0 ≥107 (2.0%)6 (2.1%)1 (1.6%)2 (2.0%)4 (1.9%)1 (2.3%)Advanced adenomaaAdvanced adenoma defined as an adenoma ≥10 mm in diameter or any adenoma (regardless of size) with villous histology, high-grade dysplasia, or cancer.7 (2.0%)6 (2.1%)1 (1.6%)2 (2.0%)4 (1.9%)1 (2.3%)NOTE. Percentages based on the number of patients in each column.a Advanced adenoma defined as an adenoma ≥10 mm in diameter or any adenoma (regardless of size) with villous histology, high-grade dysplasia, or cancer. Open table in a new tab In terms of location, 20.3% of all completers had a distal polyp (at, or distal to, the splenic flexure), 8.8% had a proximal polyp, and 5.1% had both proximal and distal polyps. The site distribution was not related to sex, ethnicity, or age (data not shown).Among the 58 patients with an adenoma, approximately half (31 of 58; 53%) had more than one adenoma. As expected, the vast majority were small (≤5 mm), tubular adenomas with low-grade dysplasia. However, 7 of 58 (12%) adenoma patients had an adenoma with villous histology, 7 of 58 (12%) had an adenoma larger than 1 cm, and 3 of 58 (5%) had an adenoma with high-grade dysplasia or cancer. There were no statistical differences in these pathologic parameters between sexes or ethnic groups.Considering advanced adenomas as any lesion at least 10 mm in diameter, villous, high-grade dysplasia or carcinoma, 7 of 353 (2%) patients who completed SC had an advanced adenoma. The mean age of patients with an advanced adenoma (56.7 ± 11.0 y) was similar to those with a nonadvanced adenoma (56.6 ± 5.1 y). Curiously, each of the cancers, and the adenoma with high-grade dysplasia, occurred in Hispanic women. One" @default.
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• W2003032015 title "A Program to Enhance Completion of Screening Colonoscopy Among Urban Minorities" @default.
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