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

Correia A, Rabeneck L, Baxter NN, Paszat LF, Sutradhar R, Yun L, Tinmouth J. Prev Med. 2015; 76:115-22. Epub 2015 Apr 17.

Background — Colon Cancer Check (CCC), Ontario's organized colorectal cancer (CRC) screening program, uses guaiac fecal occult blood testing (gFOBT). To reduce CRC-related mortality, persons with a positive gFOBT must have colonoscopy. We identified factors associated with failure to have colonoscopy within 6 months of a positive gFOBT.

Methods — Population-based, retrospective cohort analysis of CCC participants with positive gFOBT (April 2008 to December 2009) using health administrative data. Patient, physician and health care utilization factors associated with a lack of follow-up colonoscopy were identified using descriptive and multivariate analyses.

Results — There were 21,839 participants with a positive gFOBT; 14,091 (64%) had colonoscopy within 6 months. The strongest factors associated with failure to follow-up were recent colonoscopy (in 2 years prior vs. >10 years or never, OR: 4.31, 95% C.I.: 3.82, 4.86), as well as repeat gFOBT (OR: 6.08, 95% C.I.: 5.46, 6.78) and hospital admission (OR: 4.35, 95% C.I.: 3.57, 5.26) in the follow-up period.

Conclusion — In the first 18 months of the CCC Program, 1/3 of those with a positive gFOBT did not have colonoscopy within 6 months. Identification of potentially modifiable factors associated with failure to follow up lay the groundwork for interventions to address this critical quality gap.

Keywords: Colorectal cancer Colonoscopy Screening and prevention