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Barriers to Full Colon Evaluation for a Positive Fecal Occult Blood Test

¹ Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center; ² Department of Medicine, Division of Gastroenterology and ³ Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina and ⁴ Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Requests for reprints: Deborah A. Fisher, Durham Veterans Affairs Medical Center, Duke University Medical Center, 508 Fulton Street, Building 6, Durham, NC 27705. Phone: 919-286-2287; Fax: 919-416-5839. E-mail: deborah.fisher{at}duke.edu

Background: Failure to appropriately evaluate a positive cancer screening test may negate the value of doing that test. The primary aim of this study was to explore the factors associated with undergoing a full colon evaluation for a positive fecal occult blood test (FOBT) in a single Veterans Affairs center.

Methods: Medical records of consecutive patients ages 50 years, who had a positive screening FOBT from March 2000 to February 2001, were abstracted. Patient demographics, dates of ordering and doing follow-up test(s), and adherence with scheduled procedures were collected. The primary outcome, full colon evaluation, was defined as having a colonoscopy or double-contrast barium enema plus flexible sigmoidoscopy completed within 12 months.

Results: The sample (N = 538) was 98% men (58% Caucasian, 29% African-American, and 13% unknown race). Approximately 77% of the patients were referred to gastroenterology. Ultimately, only 44% underwent full colon evaluation within 12 months. Approximately 20% of the patients failed to attend a scheduled procedure. Referral to gastroenterology and adherence to follow-up appointments were associated with full colon evaluation. There was no association between African-American versus Caucasian race and full colon evaluation.

Conclusions: Less than half of the patients with a positive FOBT had a full colon evaluation within 12 months. Multiple failures were identified, including lack of referral for further testing and patient nonadherence. Although the overall performance in evaluating a positive colorectal cancer screening test was poor, no racial disparity was observed. (Cancer Epidemiol Biomarkers Prev 2006;15(6):1232–5)

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