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Volume 8: No. 3, May 2011

COMMUNITY CASE STUDY
Collaboration to Increase Colorectal Cancer Screening Among Low-Income Uninsured Patients

The first step is to determine whether the person is low-income uninsured. If no, then the person is referred through usual channels via the Referral Coordinator. If yes, then the person’s age determines the next step.

If the person is aged less than 50 years, then their level of risk is determined (high risk or intermediate risk). After a FOBT, high-risk people with either a positive or a negative test receive APA referral even without gastrointestinal symptoms. Intermediate-risk persons with a positive FOBT receive a referral for a colonoscopy. Intermediate-risk persons with a negative FOBT are recommended to receive a repeat FOBT in 6 months. If that test is positive, the person receives a referral for a colonoscopy. If that test is negative, then the process is ended and the person should consider a flexible sigmoidoscopy.

If the person is aged 50 years or older, a screening FOBT with a negative result ends the process and the person should consider a flexible sigmoidoscopy. If the screening test is positive, the person receives a referral for a colonoscopy. If the person is at intermediate risk, an FOBT with either a negative or positive test results in a referral for a colonoscopy. If the person is at high risk, an FOBT with either a negative or positive test results in a referral to Anchorage Project Access even if the person has no gastrointestinal symptoms.

Figure 2. Referral flow chart, Anchorage Neighborhood Health Center, 2009. Note: FOBT should be performed on all referrals. A negative test does not necessarily deflect referral when appropriate but is helpful collateral information. Definitions: intermediate risk, no specific gastrointestinal symptoms and either family history or weight loss; high-risk, a person with a history of colon cancer, first degree family history, or change in stool pattern and rectal bleeding or unexplained weight loss. Abbreviations: FOBT, fecal occult blood test; APA, Anchorage Project Access; RFL, Ride for Life Alaska funding; flex sig, flexible sigmoidoscopy; GI, gastrointestinal; sxs, symptoms.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


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