Longitudinal Adherence With Fecal Occult Blood Test Screening in Community Practice

Joshua J. Fenton; Joann G. Elmore; Diana S. M. Buist; Robert J. Reid; Daniel J. Tancredi; Laura-Mae Baldwin

doi:10.1370/afm.1133

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Figure 1.
Colorectal cancer test use in 2002–2003 among patients who initiated fecal occult blood test screening in 2001–2002.
CRC = colorectal cancer; Colon/BE = colonoscopy and/or barium enema; FOBT = fecal occult blood test; Sig = sigmoidoscopy.

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Table 1.

Characteristics of Patients Who Completed Fecal Occult Blood Testing during Baseline Period by Use of Colorectal Cancer Screening during 2-Year Observation Period (N = 11,110)

	CRC Screening, 2002–2003
Characteristic	Completed 3-Card FOBT (n=4,928)	CRC Test Other Than FOBT (n=978)	No CRC Screening (n=5,204)	P Value^a
CRC=colorectal cancer; FOBT=fecal occult blood test.
^a P value for overall test of between-group differences (corrected for patient clustering within primary care practices.
^b Observation period was 2002–2003; baseline period was 2000–2001.
Mean age (SD), y	63.9 (8.2)	62.1 (7.6)	63.6 (8.4)	<.001
Male sex, %	42.1	38.5	41.8	.14
Charlson Comorbidity Index, %				<.001
0	78.2	77.0	70.8
1	15.3	14.5	17.5
2	6.6	5.1	7.1
≥3	3.5	3.4	4.7
Outpatient visits, 2002–2003
Primary care visits, mean (SD), No.	10.3 (9.5)	10.9 (9.8)	9.4 (10.4)	<.001
Non–primary care visits, mean (SD), No.	6.6 (7.6)	7.7 (8.0)	6.5 (8.0)	<.001
Preventive health examination during observation period, %^b	84.8	57.7	35.2	<.001

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Table 2.

Adjusted Relative Rate Ratios of Adherence With Fecal Occult Blood Testing and Colorectal Cancer Tests Without FOBT by Patient Characteristics (N=11,110)

Outcome	RRR^a(95% CI)
CRC=colorectal cancer; FOBT=fecal occult blood test; ref=reference category; PHE = preventive health examination; RRR = relative rate ratio.
^a Relative rate ratio of CRC screening outcome compared with no CRC screening associated with change in covariate value.
^b P for linear trend <.001.
Adherent with FOBT vs no screening
Age, year	1.02 (1.02–1.03)
Male sex	1.44 (1.31–1.58)
Charlson Comorbidity Index	1.0 (ref)^b
0	0.78 (0.68–0.88)
1	0.93 (0.76–1.13)
2	0.53 (0.40–0.69)
≥3
No. of primary care visits (2002–2003)	1.01 (1.00–1.02)
No. of non–primary care visits (2002–2003)	1.00 (0.99–1.01)
Preventive health examination (PHE) during observation period (2002–2003)	11.16 (9.61–12.96)
Adherent with CRC tests other than FOBT vs no screening
Age, year	0.98 (0.97–0.99)
Male sex	1.03 (0.88–1.21)
Charlson Comorbidity Index	1.0 (ref)^b
0	0.80 (0.65–1.00)
1	0.68 (0.50–0.92)
2	0.63 (0.42–0.96)
≥3
No. of primary care visits (2002–2003)	1.01 (1.00–1.02)
No. of non–primary care visits (2002–2003)	1.02 (1.01–1.03)
PHE during observation period (2002–2003)	2.36 (2.02–2.75)

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The Article in Brief

Longitudinal Adherence With Fecal Occult Blood Test Screening in Community Practice

Joshua J. Fenton , and colleagues

Background Screening with fecal occult blood testing (FOBT) reduces colorectal cancer mortality, but its effectiveness may diminish if patients do not get repeated screenings. This study assessed subsequent screening among patients who previously received a fecal occult blood test.

What This Study Found Nearly one-half of patients who initiated FOBT screening on a 2-year basis did not receive colorectal screening in the following 2-year observation period.

Implications

Programs to promote regular screening may be necessary to achieve high effectiveness in fecal occult blood testing.