Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium

Beaber, Elisabeth F.; Tiro, Jasmin A.; Kim, Jane; McCarthy, Anne Marie; Quinn, Virginia P.; Doria-Rose, V. Paul; Wheeler, Cosette M.; Barlow, William E.; Bronson, Mackenzie; Garcia, Michael P.; Corley, Douglas A.; Haas, Jennifer S.; Halm, Ethan A.; Kamineni, Aruna; Rutter, Carolyn M.; Tosteson, Tor D.; Trentham‐Dietz, Amy; Weaver, Donald L.

doi:10.1007/s11606-015-3552-7

Cited by 36 publications

(50 citation statements)

References 37 publications

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“…Timely follow-up was defined as receipt of colonoscopy within 3 months of the abnormal result. 30 The length of the follow-up period varied by patient, depending on the date on which the test was completed. The minimum follow-up period was 12 months; the maximum was 36 months (median, 23 months).…”

Section: Methodsmentioning

confidence: 99%

Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly

Klabunde

Zheng

Quinn

et al. 2016

American Journal of Preventive Medicine

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Introduction Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings. Methods A population-based, longitudinal cohort study was conducted among health plan members aged 65–89 years enrolled during 2011–2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity–specific percentages of patients for two outcomes: colorectal cancer screening uptake, and follow-up of abnormal fecal blood tests. Results Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age, and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up. Conclusions In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly.

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Section: Methodsmentioning

confidence: 99%

Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly

Klabunde

Zheng

Quinn

et al. 2016

American Journal of Preventive Medicine

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“…Also, most prior studies have been restricted to healthcare settings such as the Veterans Administration (VA) (3, 5, 9, 12–14), individual health maintenance organizations (HMOs) (6, 7), or international screening programs (4, 5, 10, 11) whose results may not be more broadly generalizable within the United States (U.S.). There is increasing interest in studying follow-up to abnormal screening tests in a multi-level context (15, 16), but to date, few studies have compared follow-up times across healthcare systems. Such studies are needed to lay the groundwork for future research on improving the effectiveness of cancer screening.…”

Section: Introductionmentioning

confidence: 99%

Time to Colonoscopy after Positive Fecal Blood Test in Four U.S. Health Care Systems

Chubak

Garcia

Burnett‐Hartman

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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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.

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“…This approach also requires that single-nucleotide polymorphism genotyping, coupled with genetic counselling for women at high risk, is more widely available than at present. While precision screening may decrease false positives, the full efficacy of screening will only be achieved if systems are also created to manage the timely diagnostic evaluation of abnormalities that result from screening (19). These issues highlight the need to evaluate delivery systems to optimize care across the screening continuum.…”

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confidence: 99%