{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T19:05:26Z","timestamp":1789326326500,"version":"build-2803163510"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States. Although screening colonoscopy is effective, access barriers and long wait times limit its use. Stool-based fecal occult blood testing (FOBT) has emerged as an alternative screening strategy for average-risk patients. Rural populations often experience worse health care outcomes, making it important to evaluate whether implementation of stool-based screening affects follow-up care in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective single-institution observational study evaluating patients \u226518\u00a0years old who had a positive stool-based test between January and December 2024. Patients were categorized as rural or non-rural based on Rural-Urban Commuting Area codes derived from home ZIP codes. Primary outcomes included follow-up colonoscopy rates, time to diagnostic colonoscopy, and colonoscopy findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 688 patients met inclusion criteria, including 494 (72%) non-rural and 194 (28%) rural patients. Follow-up colonoscopy rates were 92% non-rural vs 88% rural,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.1002. Median time from the positive stool-based test to colonoscopy was similar between groups (53 days vs 44 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.10). Rural patients were more likely to undergo colonoscopy at an outside facility (12% vs 5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.008). Overall polyp detection rates were comparable (91% vs 92%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.87), with similar rates of tubular and tubulovillous adenomas.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of a stool-based CRC screening strategy was successful without causing delays for rural patients, with high rates of follow-up for both rural and non-rural patients. These findings suggest that stool-based screening can reasonably implemented without increasing health care barriers for rural patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261486924","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:19:27Z","timestamp":1789125567000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Maintaining Equitable Follow-Up After Positive Stool-Based Colorectal Cancer Screening in Rural Populations"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9582-0922","authenticated-orcid":false,"given":"Anthony J.","family":"Duncan","sequence":"first","affiliation":[{"name":"University of North Dakota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9436-562X","authenticated-orcid":false,"given":"Samuel J.","family":"Bloomsburg","sequence":"additional","affiliation":[{"name":"University of North Dakota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joclyn Seiler","family":"Hall","sequence":"additional","affiliation":[{"name":"University of North Dakota"},{"name":"Sanford Medical Center Fargo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21772"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.5114\/pg.2018.81072"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tranon.2021.101174"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.4417"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2022.02.001"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000113"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i20.3632"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEG.S86419"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm15010041"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16152746"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12425"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-13161-2"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2798"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.22605\/RRH7769"},{"issue":"5","key":"e_1_3_4_16_2","first-page":"363","article-title":"Addressing rural health challenges head on","volume":"114","author":"Nielsen M","year":"2017","unstructured":"Nielsen M, D'Agostino D, Gregory P. Addressing rural health challenges head on. Mo Med. 2017;114(5):363-366.","journal-title":"Mo Med"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-011-9439-6"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23132"},{"key":"e_1_3_4_19_2","unstructured":"Rural-Urban Commuting Area Codes. Economic Research Service. Accessed 2024.https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes\/"},{"key":"e_1_3_4_20_2","volume-title":"A Language and Environment for Statistical Computing","year":"2023","unstructured":"A Language and Environment for Statistical Computing. 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