Challenges in the Management of Positive Fecal Occult Blood Tests

Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers

“…Alternatively, policies should be changed to allow CHCs to directly bill for FITs at rates that would cover the costs of equipment, testing, and outreach. The second barrier limiting the effectiveness of outreach is that in our study and others [8][9][10], the rate of completion of colonoscopy following a positive FIT was low (54.1 %) despite an aggressive navigator program and a program that made colonoscopy available at no cost to patients. The reasons for this are unclear.…”

Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices

“…In our study, vulnerable populations (those living in lower income neighborhoods and immigrants) were more likely not to have a follow-up colonoscopy. Other studies have shown similar findings among the under-and uninsured (Choi et al, 2012;Rao et al, 2009) and persons living in deprived areas (Ferrat et al, 2013;Morris et al, 2012;Steele et al, 2010). Non-white ethnicity has also be shown to be a factor associated with failure to have appropriate follow-up after an abnormal gFOBT (Ferrat et al, 2013;Gellad et al, 2009;Morris et al, 2012;Moss et al, 2012).…”

“…British and European guidelines indicate that at least 85% of patients with abnormal gFOBT should have follow-up colonoscopy (Chilton and Rutter, 2010;European Commission, 2010). Failure to have a follow-up colonoscopy after positive gFOBT has been associated with inappropriate physician recommendation (Baig et al, 2003;Jimbo et al, 2009;Lurie and Welch, 1999;Nadel et al, 2005;Shields et al, 2001) (e.g., repeat gFOBT or incomplete colonoscopic evaluation), being a solo practitioner , as well as patient factors such as residence in high depravation/ low SES neighborhoods (Ferrat et al, 2013;Morris et al, 2012;Moss et al, 2012;Steele et al, 2010), non-compliance (Baig et al, 2003;Fisher et al, 2006;Jimbo et al, 2009), ethnicity (Ferrat et al, 2013;Morris et al, 2012;Moss et al, 2012), insurance status (Choi et al, 2012;Rao et al, 2009), and recent colonoscopy (Carlson et al, 2011;Fisher et al, 2006;Jimbo et al, 2009;Rao et al, 2009;Van Kleek et al, 2010).…”

Optimizing the Quality of the Colorectal Cancer Screening Continuum: A Call to Action

“…Failure to complete diagnostic colonoscopy and detect all lesions results in missed opportunities for early detection and prevention. Prior work has shown that complete diagnostic colonoscopy follow-up rates after abnormal guaiac FOBT and FIT may be as low as 22% (9)(10)(11)(12). Further, a recent modeling study has suggested that delay in follow-up results in higher CRC stage at presentation, incidence, and mortality; the relative reduction in life-years gained associated with screening was estimated to be 10% lower for diagnostic colonoscopy within two weeks vs 12 months after a positive FIT (13).…”