S546 Conventional Patient Demographics Do Not Predict Completion of Two-Step Colorectal Cancer Screening

Introduction: There are multiple screening modalities for colorectal cancer (CRC), including stool-based options such as fecal immunochemical testing and multitarget stool DNA. The use of these non-invasive options is a 2-step process requiring a colonoscopy, if positive. This study aims to identify patient and systemic factors that influence time to follow-up colonoscopy after a positive stool-based screening test in our urban, tertiary-care center. Methods: Our electronic health record (EHR) was queried for individuals aged 45-85 years old who had a positive stool-based CRC screening test between 7/1/2021 and 1/1/2024. Charts were reviewed for patient demographic data, whether a follow-up colonoscopy was completed, and colonoscopy results, including pathology. As a surrogate for economic disparity, each patient was assigned a value corresponding to the Distressed Communities Index (DCI), which stratifies U.S. zip codes based on economic health. Results: Out of 426 patients, 53.5% were female with a mean age of 64 (±9.1) years; 58% identified as White, and 93% were primarily English-speaking. In this cohort, 58.5% (n = 249) of patients had a confirmed follow-up colonoscopy, with 56.5% of these completed within 90 days of a positive test. Overall, 25.4% of patients lived in a ‘distressed’ area and 19% in an ‘at-risk’ area based on DCI. There was no difference in the rate of follow-up colonoscopy based on a variety of factors, including sex, age, race, ethnicity, insurance type, or DCI. Lastly, there was no significant difference in the rate of advanced pathology (including malignancy) based on observed demographic categories, including age (P = 0.701), sex (P = 0.067), race (P = 0.798), ethnicity (P = 0.333). Medicare patients were more likely to have advanced pathology compared to Medicaid or commercial insurance (48.8% vs 25.7% vs 14.3%, P = 0.05). Conclusion: Our data did not show significant differences in the rate of completed colonoscopy based on patient demographics or the Distressed Communities Index. Importantly, patient demographics other than insurance type did not affect the rate of advanced pathology. As use of 2-step stool-based screening for CRC increases, it is vital to identify barriers to completion of colonoscopy. Screening tests without appropriate follow-up occurred at a high rate in this cohort, suggesting that new methods to identify those at risk of failing the 2-step CRC screen are needed.