TY - JOUR
T1 - Time to colonoscopy after positive fecal blood test in four U.S. health care systems
AU - Chubak, Jessica
AU - Garcia, Michael P.
AU - Burnett-Hartman, Andrea N.
AU - Zheng, Yingye
AU - Corley, Douglas A.
AU - Halm, Ethan A.
AU - Singal, Amit G.
AU - Klabunde, Carrie N.
AU - Doubeni, Chyke A.
AU - Kamineni, Aruna
AU - Levin, Theodore R.
AU - Schottinger, Joanne E.
AU - Green, Beverly B.
AU - Quinn, Virginia P.
AU - Rutter, Carolyn M.
N1 - Publisher Copyright:
© 2016 American Association for Cancer Research.
PY - 2016/2
Y1 - 2016/2
N2 - Background: To reduce colorectal cancer mortality, positive fecal blood tests must be followed by colonoscopy. Methods: We identified 62,384 individuals ages 50 to 89 years with a positive fecal blood test between January 1, 2011 and December 31, 2012 in four health care 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 (CI) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. HRs and 95% CIs were estimated from multivariate Cox proportional hazards models. Results: Most patients who received a colonoscopy did so within 6 months of their positive fecal blood test, although follow-up rates varied across health care 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 health care systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower followup rates. Conclusion: Individual characteristics and health care system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across health care systems, but proportions of patients receiving follow-up varied. These findings suggest that there is room to improve follow-up of positive colorectal cancer 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.
AB - Background: To reduce colorectal cancer mortality, positive fecal blood tests must be followed by colonoscopy. Methods: We identified 62,384 individuals ages 50 to 89 years with a positive fecal blood test between January 1, 2011 and December 31, 2012 in four health care 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 (CI) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. HRs and 95% CIs were estimated from multivariate Cox proportional hazards models. Results: Most patients who received a colonoscopy did so within 6 months of their positive fecal blood test, although follow-up rates varied across health care 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 health care systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower followup rates. Conclusion: Individual characteristics and health care system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across health care systems, but proportions of patients receiving follow-up varied. These findings suggest that there is room to improve follow-up of positive colorectal cancer 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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U2 - 10.1158/1055-9965.EPI-15-0470
DO - 10.1158/1055-9965.EPI-15-0470
M3 - Article
C2 - 26843520
AN - SCOPUS:84957812790
SN - 1055-9965
VL - 25
SP - 344
EP - 350
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 2
ER -