{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:58Z","timestamp":1785545098775,"version":"3.56.0"},"reference-count":17,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cancer"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Cancer is the second leading cause of death in the United States. Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through the removal of precancerous polyps. The Healthy People 2030 goal for CRC screening is 68.3%, but only 36.5% of Missouri federally qualified health center patients aged 50\u201075 years are up-to-date on CRC screening. For average risk patients, there are three commonly used screening tests in the United States\u2014two types of stool tests collected at home (fecal immunochemical test [FIT]\u2013immunochemical fecal occult blood test [FOBT] and FIT-DNA, such as Cologuard) and colonoscopies completed at procedural centers.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to examine variation by month for the three types of CRC testing to evaluate consistent patient care by clinical staff.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data from 31 federally qualified health center clinics in Missouri from 2011 to 2023 were analyzed. A sample of 34,124 unique eligible \u201caverage risk\u201d patients defined as persons not having a personal history of CRC or certain types of polyps, family history of CRC, personal history of inflammatory bowel disease, and personal history of receiving radiation to the abdomen or pelvic to treat a previous cancer or confirmed or suspected hereditary CRC syndrome. Another eligibility criterion is that patients need to be seen at least once at the clinic to be included in the denominator for the screening rate calculation. Descriptive statistics characterize the sample, while bivariate analyses assess differences in screening types by month.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Completion of CRC screening yielded statistically significant differences for patients completing the different types of CRC screening by month. October-January had the highest proportions of patients (644-680 per month, 8.5%\u201010.2%) receiving a colonoscopy, while February-April had the lowest (509-578 per month, 6.9%\u20107.8%), with 614 being the average monthly number of colonoscopies. For FIT-FOBT, June-August had the higher proportions of patients receiving this test (563-613 per month, 8.9%\u20109.6%), whereas December-February had the lowest (453-495 per month, 7.1%\u20108%), with 541 being the average monthly number of FIT-FOBT kits used. For FIT-DNA, March was the most popular month with 11.3% (n=261 per month) of patients using the Cologuard test, followed by April, May, and November (207-220 per month, 8.7%\u20109.4%), and January and June (168-171 per month, 7.2%-7.3%) had the lowest proportion of patients using Cologuard, with 193 being the average monthly number of FIT-DNA kits used. Combining all tests, February had the fewest CRC tests completed (1153\/16,173, 7.1%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Home-based tests are becoming popular, replacing the gold standard colonoscopy, but need to be repeated more frequently. Monthly variation of screening over the course of a year suggests that CRC screening efforts and patient care may be less than ideal. Months with lower rates of screening for each type of CRC test represent opportunities for improving CRC screening.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/64809","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T19:05:06Z","timestamp":1739991906000},"page":"e64809-e64809","source":"Crossref","is-referenced-by-count":1,"title":["Monthly Variations in Colorectal Cancer Screening Tests Among Federally Qualified Health Center Patients in Missouri: Quality Improvement Project"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7518-747X","authenticated-orcid":false,"given":"Jane A","family":"McElroy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8304-313X","authenticated-orcid":false,"given":"Jamie B","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8302-5128","authenticated-orcid":false,"given":"Kevin D","family":"Everett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"R1","unstructured":"Cancer facts & figures. American Cancer Society. 2024. URL: https:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/annual-cancer-facts-and-figures\/2024\/2024-cancer-facts-and-figures-acs.pdf [Accessed 13-03-2025]"},{"key":"R2","unstructured":"Increase the proportion of adults who get screened for colorectal cancer \u2014 C\u201107: data methodology and measurement. Office of Disease Prevention and Health Promotion. 2024. URL: https:\/\/health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/cancer\/increase-proportion-adults-who-get-screened-colorectal-cancer-c-07\/data-methodology [Accessed 13-03-2025]"},{"key":"R3","unstructured":"National health center program uniform data system (UDS) awardee data - archive. Health Resources & Services Administration. 2024. URL: https:\/\/web.archive.org\/web\/20241220121332\/https:\/\/data.hrsa.gov\/tools\/data-reporting\/program-data\/national [Accessed 18-03-2025]"},{"key":"R4","unstructured":"What is a health center?Health Resources & Services Administration. 2024. URL: https:\/\/bphc.hrsa.gov\/about-health-center-program\/what-health-center [Accessed 13-03-2025]"},{"issue":"6","key":"R5","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1001\/jamainternmed.2024.0693","article-title":"National breast, cervical, and colorectal cancer screening use in federally qualified health centers","volume":"184","author":"Amboree","journal-title":"JAMA Intern Med"},{"issue":"7","key":"R6","doi-asserted-by":"publisher","first-page":"e222","DOI":"10.37765\/ajmc.2023.89402","article-title":"A \u201csludge audit\u201d for health system colorectal cancer screening services","volume":"29","author":"Rockwell","journal-title":"Am J Manag Care"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1016\/j.cgh.2022.12.014","article-title":"Stool-based tests mitigate impacts of COVID-19 on colorectal cancer screening","volume":"21","author":"Liu","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2022-000929","article-title":"Regional variations and associations between colonoscopy resource availability and colonoscopy utilisation: a population-based descriptive study in Ontario, Canada","volume":"9","author":"Webber","journal-title":"BMJ Open Gastroenterol"},{"issue":"15","key":"R9","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70040","article-title":"Barriers and proposed solutions to at-home colorectal cancer screening tests in medically underserved health centers across three US regions to inform a randomized trial","volume":"13","author":"Brodney","journal-title":"Cancer Med"},{"issue":"19","key":"R10","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1001\/jama.2021.6238","article-title":"Screening for colorectal cancer: US Preventive Services Task Force recommendation statement","volume":"325","author":"US Preventive Services Task Force","journal-title":"JAMA"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","journal-title":"J Biomed Inform"},{"issue":"11","key":"R12","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1007\/s11606-007-0289-y","article-title":"Physician-patient communication about colorectal cancer screening","volume":"22","author":"Wolf","journal-title":"J Gen Intern Med"},{"issue":"11","key":"R13","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1007\/s11606-009-1108-4","article-title":"Behind closed doors: physician-patient discussions about colorectal cancer screening","volume":"24","author":"McQueen","journal-title":"J Gen Intern Med"},{"issue":"5","key":"R14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011086","article-title":"Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys","volume":"6","author":"Selby","journal-title":"BMJ Open"},{"issue":"8","key":"R15","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1007\/s11606-019-05096-2","article-title":"Screening refusal associated with choice of colorectal cancer screening methods. a cross-sectional study among Swiss primary care physicians","volume":"34","author":"Martin","journal-title":"J Gen Intern Med"},{"issue":"2","key":"R16","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21020126","article-title":"Improving guideline-recommended colorectal cancer screening in a federally qualified health center (FQHC): implementing a patient navigation and practice facilitation intervention to promote health equity","volume":"21","author":"Glaser","journal-title":"Int J Environ Res Public Health"},{"issue":"9","key":"R17","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000730","article-title":"A quality improvement study on colonoscopy wait times in underinsured patients following the COVID-19 pandemic","volume":"15","author":"Shim","journal-title":"Clin Transl Gastroenterol"}],"container-title":["JMIR Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/cancer.jmir.org\/2025\/1\/e64809","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:30:11Z","timestamp":1785537011000},"score":1,"resource":{"primary":{"URL":"https:\/\/cancer.jmir.org\/2025\/1\/e64809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,19]]},"references-count":17,"URL":"https:\/\/doi.org\/10.2196\/64809","relation":{},"ISSN":["2369-1999"],"issn-type":[{"value":"2369-1999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,19]]},"article-number":"v11i6e64809"}}