Cancer

Background:

Effectiveness of colorectal cancer (CRC) screening with fecal immunochemical stool blood tests (FIT) requires high rates of colonoscopy follow up for abnormal FIT, and use of high quality tests. We characterized colonoscopy referral and completion among patients with abnormal FIT, and type of FIT implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs).

Methods:

FQHCs in San Diego, Imperial, and Los Angeles counties were invited to define a cohort of ≥150 consecutive abnormal FIT patients 2015–2016 and provide data on gender, insurance status, diagnostic colonoscopy referral and completion within six months of abnormal FIT, and type (brand) of FIT implemented. Primary outcomes were proportion with colonoscopy referral and completion for all patients at each FQHC and in aggregate.

Results:

Eight FQHCs provided data for 1,229 patients with abnormal FIT; 46% were male and 20% uninsured. Among abnormal FIT patients, 89% (n=1,091/1,229; 95%CI: 0.87–0.91) had colonoscopy referral and 44% (n=539/1,229; 95%CI: 0.41–0.47) had colonoscopy completion. Across FQHCs, range for colonoscopy referral was 73–96% and completion was 18–57%. Six of eight (75%) FQHCs reported FIT brands with limited data to support effectiveness.

Conclusions:

In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FIT was substantially below the nationally recommended benchmark to achieve 80% completion, and use of FIT brands with limited data to support effectiveness was high. These findings suggest a need for policies and multi-level interventions to promote diagnostic colonoscopy among individuals with abnormal FIT, and use of higher quality FITs.

31479529

PMC7008958

Journal Article

CDC Public Access