Only 56% of people who tested positive on a stool-based home test for colon cancer received a follow-up colonoscopy to confirm their diagnosis, according to study results published in JAMA Network Open.
“Targeted interventions to improve overall follow-up colonoscopy rates and to cover the backlog of colonoscopies from the peak COVID-19 months (March to June 2020) are necessary to achieve the full clinical benefits from stool-based colorectal cancer screening tests,” the study authors wrote.
Stool-based tests done at home are an easy, noninvasive and effective alternative to screening colonoscopies, and studies indicate that more people are willing to use them. But if they return a positive result, they must be followed by a diagnostic colonoscopy to determine whether colon cancer is present.
Jeff Mohl, PhD, of the American Medical Group Association in Virginia, and colleagues analyzed the rates of follow-up colonoscopy after a positive stool test for colon cancer. This retrospective study included de-identified administrative claims and electronic health records data from June 2015 through June 2021 for 32,769 people across 39 health care organizations.
The study population included average-risk primary care patients ages 50 to 75. In 2021, the U.S. Preventive Services Task Force recommended colorectal cancer screening for adults starting at age 45.
The main study outcome was the rate of follow-up colonoscopy within one year after a positive stool test; the overall rate was 56%. The rates of follow-up colonoscopy within three months and six months after a positive stool test were 43% and 51%, respectively. Lower rates of follow-up were observed during the early phase of the COVID-19 pandemic.
Follow-up colonoscopy rates varied depending on type of insurance, race and ethnicity, comorbidities, the particular health care organization and the type of stool-based test. For instance, people covered by private insurance were more likely to have a follow-up colonoscopy than those on Medicare or Medicaid.
Interviews with clinicians revealed that none of them were aware of the low rates of follow-up colonoscopy. The clinicians mentioned patient difficulty with the colonoscopy preparation and procedure as well as organizational problems as reasons for the low rates.
“This study found that follow-up colonoscopy rates after a positive stool-based test result for colorectal cancer screening were low among an average-risk population,” the researchers wrote. “Socioeconomic factors and the COVID-19 pandemic were associated with lower follow-up colonoscopy rates, presenting opportunities for targeted intervention by clinicians and health care systems.”
Click here to read the study in JAMA Network Open.
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