Masterclass: Colorectal Screening Plus (Virtual) | September 2025-Robertson ASGE_Course_Presentation_Overcoming

Robertson ASGE_Course_Presentation_Overcoming_barriers

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Dr. Douglas J. Robertson discusses the complex challenge of improving colorectal cancer (CRC) screening uptake despite proven effectiveness in reducing CRC incidence and mortality. Data from national repositories and surveys (e.g., HEDIS, BRFSS, National Health Interview Survey) consistently show screening rates hovering around 60%, below the Healthy People 2020 target of 70.5%, highlighting persistent barriers. These barriers include limited access to screening, affordability issues, lack of knowledge about screening benefits and options, personal acceptance or refusal, and insufficient encouragement or reminders.<br /><br />Organized screening outreach programs, such as Kaiser Permanente Northern California’s initiative, have demonstrated significant improvements in screening participation, reductions in CRC incidence (25.5%), and mortality (52.4%). Incentives have shown a modest positive effect on screening uptake. Importantly, adherence varies by screening modality: colonoscopy offers higher sensitivity but requires more resources, while fecal immunochemical testing (FIT) is less sensitive but easier to complete.<br /><br />The COLONPREV trial comparing colonoscopy versus FIT over 10 years found no significant difference in CRC incidence or mortality, underscoring that effectiveness depends heavily on patient adherence. Studies, including randomized trials in San Francisco and Poland, reveal that offering patients choice between screening methods significantly improves participation rates compared to offering a single test option.<br /><br />Dr. Robertson emphasizes that multifaceted interventions addressing multiple barriers outperform single-component strategies. GI providers play a critical role by educating primary care providers, promoting awareness of screening options, facilitating outreach programs, and integrating electronic systems to identify and remind patients due for screening.<br /><br />Key takeaways: CRC screening reduces disease burden, but uptake remains suboptimal due to barriers. Insurance status and affordability are major predictors of adherence. Outreach, patient navigation, and importantly, providing choice of screening test, are effective strategies to overcome barriers and increase screening adherence, which is essential for successful CRC control.

Keywords

colorectal cancer screening

CRC screening uptake

screening barriers

screening outreach programs

colonoscopy sensitivity

fecal immunochemical testing (FIT)

patient adherence

multifaceted interventions

insurance and affordability

screening test choice