Background To reduce colorectal cancer (CRC) mortality, positive fecal blood tests must be followed by colonoscopy. Methods We identified 62,384 individuals aged 50–89 years with a positive fecal blood test between 1/1/2011 and 12/31/2012 in four healthcare systems within the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We estimated the probability of follow-up colonoscopy and 95% confidence intervals (CIs) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. Hazard ratios and 95% CIs were estimated from multivariate Cox proportional hazards models. Results Most patients who received a colonoscopy did so within six months of their positive fecal blood test, although follow-up rates varied across healthcare systems (p <0.001). Median days to colonoscopy ranged from 41 (95% CI, 40–41) to 174 (95% CI, 123–343); percent followed-up by 12-months ranged from 58.1% (95% CI, 51.6%–63.7%) to 83.8% (95% CI, 83.4%–84.3%) and differences across healthcare systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower follow-up rates. Conclusion Individual characteristics and healthcare system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across healthcare systems, but proportions of patients receiving follow-up varied. These findings suggest there is room to improve follow-up of positive CRC screening tests. Impact Understanding the timing of colonoscopy after positive fecal blood tests and characteristics associated with lack of follow-up may inform future efforts to improve follow-up.

Background About half of US states currently require radiology facilities to disclose mammographic breast density to women, often with language recommending discussion of supplemental screening options for women with dense breasts. Objective To examine variation in breast density assessment across radiologists in clinical practice. Design Cross-sectional and longitudinal analyses of prospectively collected observational data. Setting Thirty radiology facilities within the three breast cancer screening research centers of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. Participants Radiologists who interpreted ≥500 screening mammograms during 2011–2013 (N=83). Data on 216,783 screening mammograms from 145,123 woman aged 40–89 years were included. Measurements Mammographic breast density as clinically recorded using the four Breast Imaging-Reporting and Data System density categories (heterogeneously dense and extremely dense categories were considered “dense” for analyses); patient age, race, and body mass index (BMI). Results Overall, 36.9% of mammograms were rated as dense. Across radiologists, this percentage ranged from 6.3% to 84.5% (median 38.7%, interquartile range 22.0%), with multivariable adjustment for patient characteristics having little impact (interquartile range 20.9%). Examination of patient subgroups revealed that variation in density assessment across radiologists was pervasive in all but the most extreme patient age and BMI combinations. Among women undergoing consecutive exams interpreted by different radiologists, 17.2% (5,909/34,271) had discordant assessments of dense/non-dense status. Limitations Quantitative measures of mammographic breast density were not available for comparison. Conclusions There is wide variation in density assessment across radiologists that should be carefully considered by providers and policy makers when considering supplemental screening strategies. The likelihood of a woman being told she has dense breasts varies substantially according to which radiologist interprets her mammogram. Funding Source National Institutes of Health

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