Impact of Project SCOPE on Racial/Ethnic Disparities in Colorectal Cancer Screening: 2081

Purpose: During 2005-2009, Stony Brook University Medical Center (SBUMC) led a CDC funded project, Suffolk County Preventive Endoscopy Project (Project SCOPE), to expand colorectal cancer (CRC) screening for Suffolk County (New York) residents (age ≥50 years) who had inadequate or no insurance coverage for CRC screening. We hypothesized that this project significantly expanded CRC screening in racial/ethnic minorities at SBUMC. Methods: We conducted a retrospective analysis of colonoscopies performed at SBUMC, prior to Project SCOPE (2003-2004), during Project SCOPE (2007-2008), and after Project SCOPE (2010-2011). Colonoscopies were excluded for patients aged <50 and >80 or with a history of inflammatory bowel diseases. Clinical metadata (e.g., race/ethnicity, medical insurance) was obtained from the electronic medical record. Multiple logistic regression model was used to compare the likelihood of a patient being Hispanic or African American after adjusting for potential confounders. All marginally significant factors and their first order interactions were considered in the model based on backward selection. Results: During the three time periods, the total number of colonoscopies included in the study was 11,752. The total number of Hispanic patients undergoing colonoscopy was 146 (4.5%) in 2003-2004, 506 (12.3%) in 2007-2008, and 262 (6%) in 2010-2011. The proportion of Hispanic patients undergoing colonoscopy was significantly different between the three time periods after adjusting for potentially confounding variables (patient's age, gender, and medical insurance status [p< 0.0001]). The statistical difference between the three time periods remained significant when we only considered colonoscopies designated as screening procedures. The total number of African-American patients undergoing colonoscopy was 166 (5%) in 2003-2004, 298 (7.2%) in 2007-2008, and 255 (5.9%) in 2010-2011. However, these differences were not statistically significant after controlling for patient's age and medical insurance status. The overall detection rates of adenomas, sessile serrated polyps and adenocarcinoma on colonoscopy were respectively 25%, 0.8%, and 1.2%. Hispanic ethnicity or African-American race was not significantly associated with detection of adenoma, sessile serrated polyp, or adenocarcinoma in this study. Conclusion: Reducing financial and language barriers through Project SCOPE significantly improved CRC screening by colonoscopy among Hispanics and African Americans. Future increases in national health insurance coverage for previously uninsured populations may result in increased minority participation in CRC screening as well as an increased need for language assistance.