eP444 - Participants in a State-sponsored Screening Colonoscopy Program Have Higher Rates of Premalignant Lesions Compared to Case-matched Controls

Purpose/Background: Health inequities in the incidence and mortality of colorectal cancer (CRC) persist for low income, un- and under-insured patients. State-sponsored colorectal cancer screening programs can improve access by removing financial barriers for colonoscopy screening. The purpose of this study was to compare endoscopic findings in patients enrolled in a state-sponsored screening colonoscopy program to case-matched controls.Methods/Interventions: Low income, un- or under-insured patients between the ages of 45-75 from a single county in the deep south who had a positive FIT test, high-CRC risk factors, or who preferred colonoscopy as opposed to FIT testing were eligible for referral to the state-sponsored program. Over the program’s first year from August 2022 – August 2023, 89 patients were enrolled, and 78 patients underwent at least one colonoscopy. The state-sponsored patients were matched 1:1 to non-state sponsored patients who underwent colonoscopy procedures in the same facility by age, race, sex, and indication for colonoscopy (screening, diagnostic, or surveillance). The primary outcomes were endoscopic findings of a premalignant lesion or malignancy. Secondary outcomes included high-risk polyps (high grade dysplasia, a villous component, or >10 mm in size) and total number of polyps removed. Bivariate comparison of outcomes between matched groups was performed using McNemar’s test and the Cochran-Mantel-Haenszel tests.Results/Outcomes: A total of 78 state-sponsored patients were included in the study; The average patient age was 58.1 years, most patients identified as Black (87.0%), and screening was the most common indication for colonoscopy (80.8%). All 78 state-sponsored patients were successfully matched to 78 case-matched controls. The state-sponsored group was more likely to have a family history of colon cancer in 1st and 2nd degree relatives (13.6% and 1.2%) compared to controls (9.8% and 4.9%; p < 0.01). Bowel preparation was more often adequate in state-sponsored patients (96.3 vs. 82.7%; p < 0.01), however, the cecal intubation rates were similar (95.1% vs 86.4%; p=0.07) and the duration of scope withdrawal was similar (14.4 vs 12.3 min; p=0.07). Adenomatous polyps were more commonly found in the state-sponsored group (49.4% vs 33.3%; p=0.04). There was no difference in the total number of polyps removed per colonoscopy between the groups (1.5 vs.1.0; p=0.10). Three patients in the state sponsored group were found to have malignant lesions amendable to early surgical interventions including 1 sigmoid adenocarcinoma, 1 rectal adenocarcinoma, and 1 rectal neuroendocrine tumor. One patient in the non-state sponsored group had a sigmoid adenocarcinoma.Conclusion/

Discussion: Patient’s enrolled in a state-sponsored colonoscopy screening program for low-income, uninsured, or underinsured residents were more likely to have endoscopic findings of premalignant lesions compared to case-matched controls. Though rare, early colon malignant lesions were identified and treated. These findings highlight the significance of a state-sponsored colorectal cancer screening program for reducing colorectal cancer incidence and mortality in vulnerable patients.