Suzannah Luft, MD1, Audrey H. Calderwood, MD, MS1, Douglas J. Robertson, MD, MPH2; 1Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2White River Junction VA Medical Center / Dartmouth Medical School, White River Junction, VT
Introduction: Colonoscopy for colorectal cancer (CRC) prevention is frequently performed in older adults. Fecal immunochemical testing (FIT) is a non-invasive stool based test currently recommended for CRC screening among average risk adults age 50-75. As the burden of colonoscopy increases with age, FIT may be an appealing alternative to colonoscopy in older adults. Using survey methodology, we aimed to understand older adults’ perspectives on testing preferences for CRC prevention. Methods: We invited patients age ≥70 scheduled for screening or surveillance colonoscopy to complete both a single FIT and survey prior to their scheduled colonoscopy. After completing the FIT, patients then completed a survey about their experiences with colonoscopy and testing preferences for CRC prevention. The survey used scenarios to determine if preferences for testing would change if individuals were at low or high risk for CRC based on prior endoscopic findings. Results: 100 patients completed the survey and FIT. Average age was 74 and 50% were female. When presented with a theoretical scenario of having prior small (< 1 cm) polyps, 49.5% of patients were likely to choose FIT over colonoscopy compared with 23.5% when presented with a similar theoretical scenario in which they were to have prior large ( > 1 cm) polyps (p=0.0002). Positive family history of CRC was significantly associated with preference for colonoscopy over FIT in both scenarios (p’s < 0.03). There was no significant difference in preferences by gender, education, prior experience with colonoscopy, or recent colonoscopy findings. 56% of participants indicated that they could not imagine a scenario in which they would no longer want testing for CRC. Discussion: In this survey-based study of older adults familiar with both FIT and colonoscopy, we found that nearly half of patients would prefer FIT over colonoscopy for CRC prevention, especially in the scenario of only ever having small polyps. Positive family history of CRC was strongly associated with preference for colonoscopy over FIT. FIT may be an acceptable option for older adults and its efficacy should be explored in this population.
*Data for patients without a preference (defined as answering "neutral") are not shown in the table, but these patients were included in the total number of responses.
Disclosures: Suzannah Luft indicated no relevant financial relationships. Audrey Calderwood indicated no relevant financial relationships. Douglas Robertson: Amadix – Consultant. Freenome – Consultant. Metabolomic Technologies – Consultant.