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Background & Aims: Colorectal cancer (CRC) screening guidelines include screening colonoscopy and sequential high-sensitivity fecal occult blood testing (HSgFOBT), with expectation of similar effectiveness based on the assumption of similar high adherence. However, adherence to screening colonoscopy compared with sequential HSgFOBT has not been reported. In this randomized clinical trial, we assessed adherence and pathology findings for a single screening colonoscopy vs sequential and nonsequential HSgFOBTs. Methods: Participants aged 40–69 years were enrolled at 3 centers representing different clinical settings. Participants were randomized into a single screening colonoscopy arm vs sequential HSgFOBT arm composed of 4–7 rounds. Initial adherence to screening colonoscopy and sequential adherence to HSgFOBT, follow-up colonoscopy for positive HSgFOBT tests, crossover to colonoscopy, and detection of advanced neoplasia or large serrated lesions (ADN-SERs) were measured. Results: There were 3523 participants included in the trial; 1761 and 1762 participants were randomized to the screening colonoscopy and HSgFOBT arms, respectively. Adherence was 1473 (83.6%) for the screening colonoscopy arm vs 1288 (73.1%) for the HSgFOBT arm after 1 round (relative risk [RR], 1.14; 95% CI, 1.10–1.19; P ≤.001), but only 674 (38.3%) over 4 sequential HSgFOBT rounds (RR, 2.19; 95% CI, 2.05–2.33). Overall adherence to any screening increased to 1558 (88.5%) in the screening colonoscopy arm during the entire study period and 1493 (84.7%) in the HSgFOBT arm (RR, 1.04; 95% CI, 1.02–1.07). Four hundred thirty-six participants (24.7%) crossed over to screening colonoscopy during the first 4 rounds. ADN-SERs were detected in 121 of the 1473 participants (8.2%) in the colonoscopy arm who were adherent to protocol in the first 12 months of the study, whereas detection of ADN-SERs among those who were not sequentially adherent (n = 709) to HSgFOBT was subpar (0.6%) (RR, 14.72; 95% CI, 5.46–39.67) compared with those who were sequentially adherent (3.3%) (n = 647) (RR, 2.52; 95% CI, 1.61–3.98) to HSgFOBT in the first 4 rounds. When including colonoscopies from HSgFOBT patients who were never positive yet crossed over (n = 1483), 5.5% of ADN-SERs were detected (RR, 1.50; 95% CI, 1.15–1.96) in the first 4 rounds. Conclusions: Observed adherence to sequential rounds of HSgFOBT was suboptimal compared with a single screening colonoscopy. Detection of ADN-SERs was inferior when nonsequential HSgFOBT adherence was compared with sequential adherence. However, the greatest number of ADN-SERs was detected among those who crossed over to colonoscopy and opted to receive a colonoscopy. The effectiveness of an HSgFOBT screening program may be enhanced if crossover to screening colonoscopy is permitted. ClinicalTrials.gov, Number: NCT00102011.

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third most common cause of cancer deaths in both men and women in the United States. Blacks have been reported to have a higher incidence and mortality and a more proximal anatomic distribution of CRC compared to whites and Hispanics. However, it is unclear whether this is due to biological differences in the pathology of adenomatous polyps or lower screening rates. Existing data consisting of retrospective studies and one single center prospective study indicate that factors such as access to health care and modifiable risk factors may be responsible for these racial disparities as opposed to biological differences. Methods: In 2003, the New York City Department of Health and Mental Hygiene (NYC DOHMH) implemented the Colonoscopy Patient Navigator Program (CPNP). Ten New York City Hospital Sites, five public and five private, participated in the study. Through a one to one relationship, PN helped to bridge disparities by scheduling appointments, educating regarding bowel preparation and addressing obstacles. Data were prospectively collected from 2005 through the first quarter of 2012 from centers with at least three consecutive years of reporting while using PN. Patient information including name, contact information, gender, date of birth, ethnicity and insurance information was collected by each PN during the initial contact after the patient was referred for screening colonoscopy (sCo). Adenoma and cancer detection rates, pathology and location were recorded and stratified by patient demographic characteristics including age, gender, and race. Results: With the assistance of PN, 29,711 individuals ages 50 and older underwent complete sCo. A total of 6226 adenomas and 35 cancers were found. The prevalence of adenomas was higher among white patients than black patients (27.45% versus 19.35%, p value < 0.05) (See tables 1 and 2). With the exception of the hepatic flexure, whites had a statistically significant higher prevalence of adenomas, segment by segment, than blacks and Hispanics. Conclusion: This is a prospective multicenter center study of a large urban cohort investigating the prevalence of adenomas in blacks versus whites and Hispanics using a PN program. Preliminary data do not show that blacks have an increased risk of adenomas compared to whites and Hispanics. This suggests that the higher incidence and mortality from CRC in blacks that was reported in other studies aremore likely a function of access to colonoscopy as opposed to biologic factors. Table 1: Results of completed screening colonoscopy exams cross-tabulated by patient race (age ≥ 50)

Background: Reactivation of hepatitis B virus (HBV) infection is a well-recognized complication after immunosuppression from chemotherapeutic agents and can lead to significant morbidity and mortality. We previously reported 23 HBV reactivations in patients of diverse nationalities without association with a particular malignancy or medication. Our institution subsequently initiated a protocol in which all new patients receiving immunosuppressive therapy are screened for HBV and offered anti-viral prophylaxis. The aim of this study is to report the prevalence of HBV surface antigen (HBsAg) and HBV core antibody (HBcAb) positivity since the inception of this screening program.Methods:We conducted a prospective study of all patients at Memorial Sloan-Kettering Cancer Center who were started on immunosuppressive therapy and screened for HBV from May 2009 to November 1, 2012. Patients were screened using tests for HBsAg and HBcAb. If either of these were positive, PCR for HBV DNA was reflexively measured. Patient demographics --including type of malignancy-were recorded. Results: Between May 1 2009 and November 1 2012, 17183 patients met criteria for screening and 12,328 patients (median age 64 years [24-95], 54.4% male) were screened for HBV prior to initiation of immunosuppression (71.75% compliance). Testing revealed 78(0.6%) patients positive for both HbsAg and HbcAb (median age 58, 69.2% male).Of this group, 47/78 (60.26%) had detectable HBV DNA PCR (955766.7 mean, 521 median) .Primary diagnoses of these patients included lymphoma 6.4%, leukemia 2.6%, and myriad solid tumors 91.0%. In addition, 994 patients (8.1%) were negative for HBsAg and positive for HBcAb (median age 58, 53.2% male), Diagnoses among this group included 6.0% lymphoma, 2.0% leukemia and 92.0 % solid tumor. Of this group, 7 (0.7%) had detectable HBV DNA PCR ([41-1,740,000 IU/mL]). Conclusion: In our population screened for HBV prior to initiation of immunosuppression, we report a prevalence of 0.6% for HBsAg positive patients and 8.1% for HBsAg negative, HBcAb positive patients. Screening of these