Superior Colorectal Cancer Screening in Hepatitis C Population

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Purpose: Colorectal cancer(CRC) is the third most common type of cancer and the second leading cause of cancer related death in the United States. United States Preventative Services Task Force(USPSTF) recommends colonscopy, flexible sigmoidoscoy and high sensitivity fecal occult blood test (FOBT) as effective screening tools, but current levels of CRC screening in this country lag behind those of other routine cancer screening tests. Chronic hepatitis C patients have regular follow up visits with their gastroenterologist in addition to their primary care physicians(PCP). It is common practice for the gastroenterologist to order CRC screening for these patients. Therefore we hypothesize that these patients have a higher rate of CRC screening. Aim- •To determine the percentage of chronic hepatitis C patients undergoing CRC screening •To identify factors that influence CRC screening in this population Inclusion Criteria - •Patient with a diagnosis of chronic hepatitis C over the age of 50 seen in the outpatient primary care clinic at Metro Health Medical Center between Jun 2004 and May 2008 Exclusion Criteria - •Patients who have not had high sensitivity FOBT every year after the age of 50yrs and patients who have had incomplete colonoscopies.

Methods: Retrospective chart review was done for the following - •Age •Gender •Race •Presence of established PCP - Group A •Gastroenterology clinic visit - Group B •Regular Gastroenterology clinic follow up(Atleast every 6 months)-Group C •Initiation of hepatitis C treatment - Group D •CRC screening Data was analyzed using SAS Software and the Chi square test was used to calculate P value.

Results: We reviewed charts of 968 patients of which 429 were eligible for the study. Table 1 shows patient demographics and Table 2 depicts the outcomes of CRC screening.

Table 1: Patient demographics

Table 2: CRC screening outcome

Conclusion: In our study the average CRC screening rate for chronic hepatitis C patients was much lower compared to the national average in general population. However, CRC screening amongst chronic hepatitis C patients who were followed by gastroenterologists was higher and there is a further significant increment in the subgroup of patients who underwent treatment for Hepatitis C. Colonoscopy was the preferred screening tool and there were no patients screened by flexible sigmoidoscopy. In conclusion, patients had much higher screening rates if they were seen in the Gastroenterology clinic. Whether this would translate to lower colorectal cancers in this subgroup will necessitate larger multicenter studies.