{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:37:07Z","timestamp":1786628227171,"version":"build-2736575974"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["5R01CA247642"],"award-info":[{"award-number":["5R01CA247642"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Prim. Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Increased colorectal cancer (CRC) screening is needed to address high Alaska Native (AN) CRC rates. The study objective was to evaluate high-intensity vs. medium-intensity patient outreach using multi-target stool DNA (mt-sDNA) or colonoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A community-level, cluster-randomized clinical trial (April 29, 2021, through September 15, 2024) in 46 rural\/remote Alaska communities. Participants were asymptomatic AN adults aged 45\u201375 with no family or personal history of CRC who were due for screening. High-intensity: Up to six patient navigator telephone calls with follow-up mailer. Medium-intensity: Mailed letter with one follow-up call. Usual care: Standard of care clinical visits. The primary outcome was screening completion within 12 months. Secondary outcomes included test preference, abnormal mt-sDNA follow-up colonoscopy, and colonoscopy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2029 AN people (mean [SD] age, 56 [8.4] years; 816 women [40%]) were randomized including 587 to usual care, 696 to medium-intensity, and 746 to the high-intensity arm. Both men and women were significantly more likely to request mt-sDNA (70%) over colonoscopy (30%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), with participants\u2009\u2265\u200965 years old most likely to request mt-sDNA.\n                    <\/jats:p>\n                    <jats:p>Screening completion within 12 months among the total population was significantly higher in the medium-intensity (24%) and high-intensity arms (28%) compared with usual care (6%) (p&lt;0.01). Compared to usual care, CRC screening odds were higher with high-intensity (odds ratio [OR], 5.90; 95% CI, 3.86-9.04) and medium-intensity intervention (OR, 4.87; 95% CI, 3.18-7.46). Among those who agreed to screen, completion was similar in both intervention arms. Screening completion was 16% higher among high-intensity vs. medium-intensity participants (OR, 1.25; 95% CI, 0.91-1.71, p=0.19). Of the total eligible population, 254\/2029 people (12.5%) had valid mt-sDNA tests and 278\/2029 (13.7%) had complete colonoscopies. CRC\/advanced neoplasia was found in over 25% of initial screening colonoscopies and 59% of colonoscopies performed after abnormal mt-sDNA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both a medium- and a high-intensity intervention were significantly more effective at increasing screening initiation and completion rates compared with usual care in rural\/remote Alaskan communities. Participants significantly preferred mt-sDNA for screening. These findings highlight the clinical utility of focused outreach strategies in primary care settings and support the use of mt-sDNA as a viable alternative to colonoscopy in geographically isolated populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The study is registered with the Clinical Trials Registry (Stool DNA to Improve Colorectal Cancer Screening Among Alaska Native People, NCT04336397, https\/\/www.cancer.gov\/research\/participate\/clinicaltrialssearch\/v? id=NCI202108691, registration date 04\/03\/2020) and was designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-026-03370-x","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T01:55:09Z","timestamp":1779760509000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increasing colorectal cancer screening among Alaska Native peoples living in remote areas of Alaska: a multitarget stool DNA cluster randomized controlled trial"],"prefix":"10.1186","volume":"27","author":[{"given":"Diana","family":"Redwood","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie","family":"Flanagan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Jeffries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Holck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila Finney","family":"Rutten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Desnoyers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danika","family":"Bailie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kisiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"3370_CR1","first-page":"2023","volume-title":"Colorectal Cancer Facts & Figs","author":"American Cancer Society","year":"2023","unstructured":"American Cancer Society. Colorectal Cancer Facts & Figs. In. Atlanta, GA: American Cancer Society; 2023. pp. 2023\u20135."},{"issue":"2","key":"3370_CR2","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1053\/j.gastro.2010.06.011","volume":"139","author":"AG Zauber","year":"2010","unstructured":"Zauber AG, Lansdorp-Vogelaar I. Changes in risk factors and increases in screening contribute to the decline in colorectal cancer mortality, 1975 to 2000. Gastroenterology. 2010;139(2):698.","journal-title":"Gastroenterology"},{"issue":"1","key":"3370_CR3","doi-asserted-by":"publisher","first-page":"2184749","DOI":"10.1080\/22423982.2023.2184749","volume":"82","author":"D Haverkamp","year":"2023","unstructured":"Haverkamp D, Redwood D, Roik E, Vindigni S, Thomas T. Elevated colorectal cancer incidence among American Indian\/Alaska Native persons in Alaska compared to other populations worldwide. Int J Circumpolar Health. 2023;82(1):2184749.","journal-title":"Int J Circumpolar Health"},{"key":"3370_CR4","unstructured":"AlaskaDepartment of Health and Social Services. Alaska Behavioral Risk Factor Surveillance System Data Center. Alaska Department of Health and Social Services, Juneau, Alaska; 2024. https:\/\/alaska-dph.shinyapps.io\/BRFSS\/."},{"key":"3370_CR5","unstructured":"Summary, File. 1, Tables PCT1, PCT2, PCT3. Race Reporting for the American Indian and Alaska Native Population by Selected Tribes: 2010 [http:\/\/factfinder2.census.gov\/faces\/nav\/jsf\/pages\/index.xhtml]."},{"key":"3370_CR6","doi-asserted-by":"publisher","unstructured":"Nash SH, Verhage E, Flanagan C, Haverkamp D, Roik E, Zimpelman G, Redwood D. Clinical Outcomes from the Alaska Native Tribal Health Consortium Colorectal Cancer Control Program: 2009\u20132015. Int J Environ Res Public Health. 2024;21(5). https:\/\/doi.org\/10.3390\/ijerph21050552.","DOI":"10.3390\/ijerph21050552"},{"issue":"14","key":"3370_CR7","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1056\/NEJMoa1311194","volume":"370","author":"TF Imperiale","year":"2014","unstructured":"Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, Ahlquist DA, Berger BM. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287\u201397.","journal-title":"N Engl J Med"},{"issue":"1","key":"3370_CR8","doi-asserted-by":"publisher","first-page":"e85659","DOI":"10.1371\/journal.pone.0085659","volume":"9","author":"RI Heigh","year":"2014","unstructured":"Heigh RI, Yab TC, Taylor WR, Hussain FT, Smyrk TC, Mahoney DW, Domanico MJ, Berger BM, Lidgard GP, Ahlquist DA. Detection of colorectal serrated polyps by stool DNA testing: comparison with fecal immunochemical testing for occult blood (FIT). PLoS ONE. 2014;9(1):e85659.","journal-title":"PLoS ONE"},{"issue":"12","key":"3370_CR9","doi-asserted-by":"publisher","first-page":"2023","DOI":"10.1007\/s10552-010-9664-9","volume":"21","author":"LC Seeff","year":"2010","unstructured":"Seeff LC, Major A, Townsend JS, Provost E, Redwood D, Espey D, Dwyer D, Villanueva R, Larsen L, Rowley K, et al. Comprehensive cancer control programs and coalitions: partnering to launch successful colorectal cancer screening initiatives. Cancer Causes Control. 2010;21(12):2023\u201331.","journal-title":"Cancer Causes Control"},{"issue":"19","key":"3370_CR10","doi-asserted-by":"publisher","first-page":"4851","DOI":"10.1002\/cncr.27487","volume":"118","author":"EA Donaldson","year":"2012","unstructured":"Donaldson EA, Holtgrave DR, Duffin RA, Feltner F, Funderburk W, Freeman HP. Patient navigation for breast and colorectal cancer in 3 community hospital settings: an economic evaluation. Cancer. 2012;118(19):4851\u20139.","journal-title":"Cancer"},{"issue":"10","key":"3370_CR11","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1158\/1055-9965.EPI-12-0982","volume":"21","author":"HP Freeman","year":"2012","unstructured":"Freeman HP. The origin, evolution, and principles of patient navigation. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1614\u20137.","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"3370_CR12","unstructured":"The Guide to Community Preventive Services. Cancer Prevention and Control: Increasing breast, cervical, and colorectal cancer screening [http:\/\/www.thecommunityguide.org\/cancer\/index.html]."},{"issue":"1","key":"3370_CR13","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.amepre.2012.04.008","volume":"43","author":"Community Preventive Services Task F","year":"2012","unstructured":"Community Preventive Services Task F. Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening. Am J Prev Med. 2012;43(1):92\u20136.","journal-title":"Am J Prev Med"},{"issue":"2","key":"3370_CR14","doi-asserted-by":"publisher","first-page":"180","DOI":"10.3122\/jabfm.2019.02.180205","volume":"32","author":"KR Ylitalo","year":"2019","unstructured":"Ylitalo KR, Camp BG, Umstattd Meyer MR, Barron LA, Benavidez G, Hess B, Laschober R, Griggs JO. Barriers and Facilitators of Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC). J Am Board Fam Med. 2019;32(2):180\u201390.","journal-title":"J Am Board Fam Med"},{"key":"3370_CR15","doi-asserted-by":"publisher","first-page":"101016","DOI":"10.1016\/j.conctc.2022.101016","volume":"30","author":"CA Flanagan","year":"2022","unstructured":"Flanagan CA, Finney Rutten LJ, Kisiel JB, Lent JK, Bachtold JF, Swartz AW, Redwood DG. Development of a colorectal cancer screening intervention for Alaska Native people during a pandemic year. Contemp Clin Trials Commun. 2022;30:101016.","journal-title":"Contemp Clin Trials Commun"},{"issue":"9","key":"3370_CR16","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","volume":"89","author":"RE Glasgow","year":"1999","unstructured":"Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322\u20137.","journal-title":"Am J Public Health"},{"issue":"6","key":"3370_CR17","doi-asserted-by":"publisher","first-page":"204253331347919","DOI":"10.1177\/2042533313479197","volume":"4","author":"S Tariq","year":"2013","unstructured":"Tariq S, Woodman J. Using mixed methods in health research. JRSM short Rep. 2013;4(6):2042533313479197.","journal-title":"JRSM short Rep"},{"key":"3370_CR18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/1525822X05282260","volume":"18","author":"NV Ivankova","year":"2006","unstructured":"Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design: from theory to practice. Field Methods. 2006;18:3\u201320.","journal-title":"Field Methods"},{"key":"3370_CR19","doi-asserted-by":"crossref","unstructured":"Dickerson D, Baldwin JA, Belcourt A, Belone L, Gittelsohn J, Keawe\u2019aimoku Kaholokula J, Lowe J, Patten CA, Wallerstein N. Encompassing Cultural Contexts Within Scientific Research Methodologies in the Development of Health Promotion Interventions. Prev Sci 2018.","DOI":"10.1007\/s11121-018-0926-1"},{"key":"3370_CR20","volume-title":"Methods in community-based participatory research for health","year":"2005","unstructured":"Israel BA, Eng E, Schulz AJ, Parker EA, editors. Methods in community-based participatory research for health. San Francisco, CA: Jossey-Bass; 2005."},{"key":"3370_CR21","unstructured":"Frontier. and Remote Area Codes [https:\/\/www.ers.usda.gov]."},{"issue":"2","key":"3370_CR22","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377\u201381.","journal-title":"J Biomed Inform"},{"key":"3370_CR23","unstructured":"Exact Sciences Corporation. FDA Summary of Safety and Effectiveness Data for the Multi-Target Stool DNA (mt-sDNA) Based Colorectal Cancer Screening Test. In.; 2024: 24."},{"key":"3370_CR24","volume-title":"Alaska Behavioral Risk Factor Surveillance System","year":"2020","unstructured":"Alaska Department of Health and Social Services. In: Juneau, editor. Alaska Behavioral Risk Factor Surveillance System. AK: Alaska Department of Health and Social Services; 2020."},{"key":"3370_CR25","doi-asserted-by":"publisher","first-page":"111457","DOI":"10.1016\/j.jclinepi.2024.111457","volume":"173","author":"J Molero-Calafell","year":"2024","unstructured":"Molero-Calafell J, Buron A, Castells X, Porta M. Intention to treat and per protocol analyses: differences and similarities. J Clin Epidemiol. 2024;173:111457.","journal-title":"J Clin Epidemiol"},{"key":"3370_CR26","unstructured":"R Core Team: R: A language and environment for statistical computing. In, Vienna. Austria: R Foundation for Statistical Computing; 2021."},{"key":"3370_CR27","doi-asserted-by":"publisher","first-page":"215013272110378","DOI":"10.1177\/21501327211037892","volume":"12","author":"ME Shepherd","year":"2021","unstructured":"Shepherd ME, Lecorps A, Harris-Shapiro J, Miller-Wilson LA. Evaluating Outreach Methods for Multi-Target Stool DNA Test for Colorectal Cancer Screening Among an Employer Population. J Prim care community health. 2021;12:21501327211037892.","journal-title":"J Prim care community health"},{"key":"3370_CR28","doi-asserted-by":"publisher","first-page":"102047","DOI":"10.1016\/j.pmedr.2022.102047","volume":"30","author":"X Zhu","year":"2022","unstructured":"Zhu X, Weiser E, Griffin JM, Limburg PJ, Finney Rutten LJ. Factors influencing colorectal cancer screening decision-making among average-risk US adults. Prev Med Rep. 2022;30:102047.","journal-title":"Prev Med Rep"},{"key":"3370_CR29","unstructured":"80%. in Every Community Strategic Plan [https:\/\/nccrt.org ]."},{"key":"3370_CR30","doi-asserted-by":"publisher","first-page":"102032","DOI":"10.1016\/j.pmedr.2022.102032","volume":"30","author":"LA Miller-Wilson","year":"2022","unstructured":"Miller-Wilson LA, Finney Rutten LJ, Van Thomme J, Burak Ozbay A, Laffin J, Limburg P. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a medicaid population. Prev Med Rep. 2022;30:102032.","journal-title":"Prev Med Rep"},{"issue":"3","key":"3370_CR31","doi-asserted-by":"publisher","first-page":"464","DOI":"10.3748\/wjg.v23.i3.464","volume":"23","author":"M Prince","year":"2017","unstructured":"Prince M, Lester L, Chiniwala R, Berger B. Multitarget stool DNA tests increases colorectal cancer screening among previously noncompliant Medicare patients. World J Gastroenterol. 2017;23(3):464\u201371.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"3370_CR32","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/0969141320903756","volume":"28","author":"E Weiser","year":"2021","unstructured":"Weiser E, Parks PD, Swartz RK, Thomme JV, Lavin PT, Limburg P, Berger BM. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening: Real-world data from a large cohort of older adults. J Med Screen. 2021;28(1):18\u201324.","journal-title":"J Med Screen"},{"issue":"11","key":"3370_CR33","doi-asserted-by":"publisher","first-page":"2471","DOI":"10.1007\/s00384-021-03956-0","volume":"36","author":"LA Miller-Wilson","year":"2021","unstructured":"Miller-Wilson LA, Rutten LJF, Van Thomme J, Ozbay AB, Limburg PJ. Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort. Int J Colorectal Dis. 2021;36(11):2471\u201380.","journal-title":"Int J Colorectal Dis"},{"issue":"5","key":"3370_CR34","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1097\/01.JAA.0000000000000108","volume":"38","author":"B Strelow","year":"2025","unstructured":"Strelow B, Dorff H, Gunneson C, Katula W, Pokuta J, Vang K, Olson R, O\u2019Laughlin D. Reducing barriers to colorectal cancer screening via at-home multitarget stool DNA tests. JAAPA. 2025;38(5):42\u20133.","journal-title":"JAAPA"},{"issue":"6","key":"3370_CR35","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1053\/j.gastro.2021.01.219","volume":"160","author":"Y San Miguel","year":"2021","unstructured":"San Miguel Y, Demb J, Martinez ME, Gupta S, May FP. Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality. Gastroenterology. 2021;160(6):1997\u20132005. e1993.","journal-title":"Gastroenterology"},{"issue":"16","key":"3370_CR36","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1001\/jama.2017.3634","volume":"317","author":"DA Corley","year":"2017","unstructured":"Corley DA, Jensen CD, Quinn VP, Doubeni CA, Zauber AG, Lee JK, Schottinger JE, Marks AR, Zhao WK, Ghai NR, et al. Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis. JAMA. 2017;317(16):1631\u201341.","journal-title":"JAMA"},{"issue":"6","key":"3370_CR37","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1002\/ijc.32497","volume":"146","author":"A Beshara","year":"2020","unstructured":"Beshara A, Ahoroni M, Comanester D, Vilkin A, Boltin D, Dotan I, Niv Y, Cohen AD, Levi Z. Association between time to colonoscopy after a positive guaiac fecal test result and risk of colorectal cancer and advanced stage disease at diagnosis. Int J Cancer. 2020;146(6):1532\u201340.","journal-title":"Int J Cancer"},{"issue":"7","key":"3370_CR38","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1016\/j.cgh.2018.10.041","volume":"17","author":"YC Lee","year":"2019","unstructured":"Lee YC, Fann JC, Chiang TH, Chuang SL, Chen SL, Chiu HM, Yen AM, Chiu SY, Hsu CY, Hsu WF, et al. Time to Colonoscopy and Risk of Colorectal Cancer in Patients With Positive Results From Fecal Immunochemical Tests. Clin Gastroenterol Hepatol. 2019;17(7):1332\u201340. e1333.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"5","key":"3370_CR39","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1053\/j.gastro.2016.08.053","volume":"152","author":"DJ Robertson","year":"2017","unstructured":"Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Lieberman D, Levin TR, Rex DK. Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;152(5):1217\u201337. e1213.","journal-title":"Gastroenterology"},{"issue":"1","key":"3370_CR40","doi-asserted-by":"publisher","first-page":"61","DOI":"10.3122\/jabfm.2021.01.200345","volume":"34","author":"GS Cooper","year":"2021","unstructured":"Cooper GS, Grimes A, Werner J, Cao S, Fu P, Stange KC. Barriers to Follow-Up Colonoscopy After Positive FIT or Multitarget Stool DNA Testing. J Am Board Fam Med. 2021;34(1):61\u20139.","journal-title":"J Am Board Fam Med"},{"issue":"2","key":"3370_CR41","doi-asserted-by":"publisher","first-page":"100599","DOI":"10.1016\/j.mayocpiqo.2025.100599","volume":"9","author":"AM Chamberlain","year":"2025","unstructured":"Chamberlain AM, Ebner DW, Jenkins GD, Greene M, Finney Rutten LJ. Follow-up Colorectal Cancer Screening After Negative-Result and Positive-Result Multitarget Stool DNA Tests: A Population-Based Study in Southeast Minnesota. Mayo Clin Proc Innov Qual Outcomes. 2025;9(2):100599.","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"3370_CR42","doi-asserted-by":"crossref","unstructured":"Redwood DG, Prewitt JJ, Holt MC, Gerrish SS. Elevated Adenomatous Polyp Detection Rate Among Alaska Native and American Indian People in Interior Alaska, 2018\u20132022. Public Health Rep 2023:333549221143204.","DOI":"10.1177\/00333549221143204"},{"issue":"12","key":"3370_CR43","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1016\/j.cgh.2009.05.032","volume":"7","author":"SJ Heitman","year":"2009","unstructured":"Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7(12):1272\u20138.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"3370_CR44","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1053\/j.gastro.2018.08.020","volume":"155","author":"TF Imperiale","year":"2018","unstructured":"Imperiale TF, Abhyankar PR, Stump TE, Emmett TW. Prevalence of Advanced, Precancerous Colorectal Neoplasms in Black and White Populations: A Systematic Review and Meta-analysis. Gastroenterology. 2018;155(6):1776\u201386. e1771.","journal-title":"Gastroenterology"},{"issue":"4","key":"3370_CR45","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1002\/cncr.31864","volume":"125","author":"K Rice","year":"2019","unstructured":"Rice K, Sharma K, Li C, Butterly L, Gersten J, DeGroff A. Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire. Cancer. 2019;125(4):601\u20139.","journal-title":"Cancer"},{"issue":"1 Suppl","key":"3370_CR46","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1207\/s15430154jce2101s_4","volume":"21","author":"HP Freeman","year":"2006","unstructured":"Freeman HP. Patient navigation: a community centered approach to reducing cancer mortality. J Cancer Educ. 2006;21(1 Suppl):S11\u201314.","journal-title":"J Cancer Educ"},{"issue":"23","key":"3370_CR47","doi-asserted-by":"publisher","first-page":"5982","DOI":"10.1002\/cncr.27595","volume":"118","author":"EB Elkin","year":"2012","unstructured":"Elkin EB, Shapiro E, Snow JG, Zauber AG, Krauskopf MS. The economic impact of a patient navigator program to increase screening colonoscopy. Cancer. 2012;118(23):5982\u20138.","journal-title":"Cancer"}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-026-03370-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03370-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03370-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:01:31Z","timestamp":1786626091000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12875-026-03370-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3370"],"URL":"https:\/\/doi.org\/10.1186\/s12875-026-03370-x","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"5 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"JBK is listed as an inventor of Mayo Clinic intellectual property, licensed to Exact Sciences (Madison, Wisconsin), for which he may receive royalties, paid to Mayo Clinic. He consults and receives research support under a sponsored research agreement between Mayo Clinic and Exact Sciences. LJFR owns stock in Exact Sciences, was employed by Exact Sciences from May 2022-March 2023, and currently receives funding from Exact Sciences for scientific leadership of a longitudinal cohort study. All other authors declared no conflict of interest with respect to the research, authorship, and\/or publication of this article.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"303"}}