Adherence to national guidelines for colorectal cancer screening in Israel: Comprehensive multi-year assessment based on electronic medical records

Abstract

Objectives To assess time trends in colorectal cancer screening uptake, time-to-colonoscopy completion following a positive fecal occult blood test and associated patient factors, and the extent and predictors of longitudinal screening adherence in Israel. Setting Nation-wide population-based study using data collected from four health maintenance organizations for the Quality Indicators in Community Healthcare Program. Methods Screening uptake for the eligible population (aged 50–74) was recorded 2003–2018 using aggregate data. For a subcohort (2008–2012, N = 1,342,617), time-to-colonoscopy following a positive fecal occult blood test and longitudinal adherence to screening guidelines were measured using individual-level data, and associated factors assessed in multivariate models. Results The annual proportion screened rose for both sexes from 11 to 65%, increasing five-fold for age group 60–74 and >six-fold for 50–59 year olds, respectively. From 2008 to 2012, 67,314 adults had a positive fecal occult blood test, of whom 71% eventually performed a colonoscopy after a median interval of 122 (95% confidence interval 110.2–113.7) days. Factors associated with time-to-colonoscopy included age, socioeconomic status, and comorbidities. Only 25.5% of the population demonstrated full longitudinal screening adherence, mainly attributable to colonoscopy in the past 10 years rather than annual fecal occult blood test performance (83% versus 17%, respectively). Smoking, diabetes, lower socioeconomic status, cardiovascular disease, and hypertension were associated with decreased adherence. Performance of other cancer screening tests and frequent primary care visits were strongly associated with adherence. Conclusions Despite substantial improvement in colorectal cancer screening uptake on a population level, individual-level data uncovered gaps in colonoscopy completion after a positive fecal occult blood test and in longitudinal adherence to screening, which should be addressed using focused interventions.

Current and future colorectal cancer screening strategies

“…. There are no organized CRC screening programmes in African or eastern Mediterranean regions with the exception of Israel, which has implemented an annual FIT screening for individuals 50-74 years of age84 , and Abu Dhabi, which recommends colonoscopy screening for individuals over the age of 40 years 3 . Regardless of modality, screening rates are far from ideal (often close to 20%) and efforts directed at expanding options for CRC screening, patient selection, navigation to a colonoscopy if a non-invasive test is positive and adequate follow-up are needed (TaBle2).…”

Factors associated with positive predictive value of preliminary screening in a two-step screening strategy for colorectal neoplasms in China

“…First, it suggests that males, elders (age > 60) and smokers who were identified as high-risk individuals of colorectal neoplasms in the preliminary screening stage should be given priority to refer for colonoscopy. These subpopulations, usually presenting low screening rate of CRC [39,40], need to be paid extra effort to raise their awareness and compliance for colonoscopy screening. Second, age, gender and smoking were just qualitatively incorporated in some risk scoring systems for CRC screening [41][42][43] (e.g., Asia-Pacific Colorectal Screening score).…”

Socioeconomic Disparity Trends in Cancer Screening Among Women After Introduction of National Quality Indicators

“…A recent study based on QICH data assessed the contribution that factors such as body mass index, diabetes, hypertension, and smoking had on colorectal cancer screening rates. 42 Although these factors were statistically significantly associated with reduced screening rates, their contributions to screening rates were small.…”