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Schaefer Solle N, Sussman DA, Koru-Sengul T, Seay J, Baeker-Bispo J, Kobetz EN. Feasibility of Fecal Immunochemical Testing Among Hispanic and Haitian Immigrants Living in South Florida. JAMA Intern Med. 2017;177(3):428–430. doi:10.1001/jamainternmed.2016.8689
Copyright 2017 American Medical Association. All Rights Reserved.
Reduction in colorectal cancer (CRC) incidence and mortality is substantially higher among racial/ethnic minorities, recent immigrants, and low-income individuals.1,2 In South Florida, this disparity is most prominent for foreign-born Hispanics and Haitians, particularly those who reside in Hialeah and Little Haiti. Late-stage diagnoses and poorer survival in these enclaves primarily reflect lack of access to preventive cancer screening.3 Improving CRC screening is a particular challenge for specific population subgroups, namely, the uninsured and recent immigrants.4 In this study, we trained community health workers (CHWs), individuals who were members of our target communities, to promote fecal immunochemical testing (FIT) to improve CRC screening uptake among underserved immigrant communities.
Rooted in the principles of community-based participatory research, our intervention invited collaboration from community members at all points of the research process. We included men and women who self-identified as Haitian or Hispanic, were 50 to 75 years of age, resided in Little Haiti or Hialeah, and were unscreened or underscreened for CRC based on US Multi-Society Task Force guidelines.5 Individuals with a personal history of CRC or inflammatory bowel disease and those who had undergone partial or total colectomy were excluded from participation, as well as those who were not physically capable of performing the FIT themselves.
All study procedures were approved by the University of Miami Institutional Review Board. The CHWs obtained written informed consent and delivered a short intake interview. The CHWs educated participants on CRC risk factors and screening options and provided FIT instruction through verbal directions and visual aids. The FIT results were processed in our laboratory (OC FIT-CHEK, Polymedco); stool samples with globin level greater than or equal to 100 ng/mL were considered positive. Diagnostic colonoscopy was considered successful if performed within 90 days of a positive FIT result. All participants who completed FIT received a follow-up telephone call. Frequencies and percentages of sociodemographic characteristics were calculated for the overall sample, as well as by recruitment site.
A total of 1030 individuals were screened for eligibility; 483 (70%) of the 688 eligible individuals agreed to participate (Figure). Characteristics of the sample from each site are described in the Table. A total of 479 (99%) were foreign-born with 236 (49%) Hispanic and 243 (51%) Haitian. A total of 343 (71%) lived below the federal poverty level, and 342 (71%) were uninsured.
Overall, 85% of participants (n = 410) returned the FIT kit (217 [89%] Haitian vs 193 [82%] Hispanics; P = .007) and 71% (n = 344) completed follow-up with a CHW. Completion of FIT did not differ by age, sex, education, or employment. Positive FIT results were detected from 6 (1%) participants and 3 successfully completed diagnostic colonoscopy.
The present study demonstrated that pairing a CHW with FIT for CRC screening delivery in 2 immigrant communities was feasible. This strategy was successful for CRC screening among both Haitians and Hispanics. Given that the mean national screening rate for recent immigrants and uninsured patients is approximately 21%, the 85% overall screening rate demonstrated by our participants supports CHW+FIT as a viable strategy for improving CRC screening within these populations. Our numbers are also favorable when compared with Florida’s statewide CRC screening rate of 68%.6 Eighty percent or more completed the screening in both groups, aligning with the goals of Healthy People 2020 to achieve 80% population CRC screening rates by 2018.
The proportion of abnormal FIT results (1%) was lower than expected; however, blood in stool (below the 100 ng/mL threshold) was detected in a high proportion of the samples, suggesting that sample acquisition by participants and laboratory techniques were sufficient. Our results indicate that when paired with a CHW, FIT outreach may be an effective screening strategy to increase screening rates.
Corresponding Author: Natasha Schaefer Solle, RN, PhD, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, 1120 NW 14th St, Clinical Research Bldg, Room 1232, Miami, FL 33136 (firstname.lastname@example.org).
Published Online: January 23, 2017. doi:10.1001/jamainternmed.2016.8689
Author Contributions: Drs Schaefer Solle and Kobetz had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Schaefer Solle, Sussman, Koru-Sengul, Kobetz.
Acquisition, analysis, or interpretation of data: Sussman, Koru-Sengul, Seay, Baeker-Bispo, Kobetz.
Drafting of the manuscript: Schaefer Solle, Sussman, Koru-Sengul, Seay, Kobetz.
Critical revision of the manuscript for important intellectual content: Sussman, Koru-Sengul, Seay, Baeker-Bispo, Kobetz.
Statistical analysis: Koru-Sengul, Seay, Baeker-Bispo.
Obtained funding: Sussman, Koru-Sengul, Kobetz.
Administrative, technical, or material support: Schaefer Solle, Sussman, Koru-Sengul, Seay, Kobetz.
Supervision: Sussman, Koru-Sengul, Kobetz.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was supported by Bankhead Coley Cancer Research Program (2BT02) to the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and the Jay Weiss Institute for Health Equity.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Olveen Carrasquillo, MD, MPH, University of Miami Miller School of Medicine, served as principal investigator of this team science grant and provided support and guidance throughout the study. We would also like to thank the study team staff and community health workers for their untiring effort in making this project a success, as well as the participants, who played a critical role in ensuring completion of the study as planned. No funding was received for such contributions. The Disparities and Community Outreach Core at the Sylvester Comprehensive Cancer Center provided research support services for this study.