Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death

Abstract

Background & Aims: Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow up of abnormal results, or when the screening test itself fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these events. Methods: We performed a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems (55–90 years old) who died from CRC from 2006 through 2012 and had ≥5 years of enrollment prior to diagnosis. We compared data from patients with a matched cohort of cancer-free patients in the same system. Receipt, results, indications, and follow up of CRC tests in the 10-year period prior to diagnosis were obtained from electronic databases and chart audits. Results: Among 1750 CRC deaths, 75.9% (n=1328) occurred in patients who were not up to date in screening and 24.1% (n=422) occurred in patients who were up to date. Failure to screen was associated with fewer visits to primary care physicians. Among 3486 cancer-free patients, 44.6% were up to date on their screening. Patients who were up to date in their screening had reduced risk of CRC death (odds ratio [OR], 0.38; 95% CI, 0.33–0.44). Failure to screen, or failure to screen at appropriate intervals, occurred in a 67.8% of patients who died from CRC vs 53.2% of cancer-free patients; failure to follow up on abnormal results occurred in 8.1% of patients who died from CRC vs 2.2% of cancer-free patients. CRC death was associated with higher odds of failure to screen or failure to screen at appropriate intervals (OR, 2.40; 95% CI, 2.07–2.77) and failure to follow up on abnormal results (OR, 7.26; 95% CI, 5.26–10.03). Conclusions: Being up to date on screening substantially reduces risk of CRC death. In 2 healthcare systems with high rates of screening, most people who died from CRC had failures in the screening process that could be rectified, such as failure to follow up on abnormal findings; these significantly increased risk for CRC death.

Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

“…These findings point to the importance of identifying the specific factors associated with lack of follow‐up in health settings and the application of tailored interventions that address each targeted barrier. The importance of complete follow‐up is underscored by the findings of Lee et al, who observed that the risk of CRC and advanced disease increased with the duration of time before the follow‐up examination and that FIT‐positive patients who did not receive follow‐up colonoscopy had a 1.64‐fold increased risk of CRC death compared with FIT‐positive patients who did receive follow‐up Doubeni et al reported similar findings from a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems who died of CRC from 2006 to 2012 . Whereas approximately three‐fourths of the deaths from CRC were associated with not being up to date on screening, one‐fourth occurred in patients who were current with screening recommendations.…”

“…Whereas approximately three‐fourths of the deaths from CRC were associated with not being up to date on screening, one‐fourth occurred in patients who were current with screening recommendations. Among all CRC deaths, 8.1% were attributable to failure to follow‐up a positive screening test . A recent review of interventions to improve follow‐up colonoscopy after a positive stool test indicated that patient navigators and provider feedback may improve timely follow‐up, but evidence for other system‐level interventions was unclear …”

“…Among all CRC deaths, 8.1% were attributable to failure to follow-up a positive screening test. 112 A recent review of interventions to improve followup colonoscopy after a positive stool test indicated that patient navigators and provider feedback may improve timely follow-up, but evidence for other system-level interventions was unclear. 113…”

CHIP-mediated ubiquitination of Galectin-1 predicts colorectal cancer prognosis

“…At present, the treatment of CRC is still based on surgery, chemotherapy, radiotherapy, and molecular targeted drugs [5]. Although various clinical treatment methods have made significant progress, the mortality rate of CRC is still gradually increasing, mainly due to local recurrence or distant metastasis [6,7]. The development and progression of CRC is an extremely complex process, which contain many oncogenes and tumor suppressor genes [8].…”

Colorectal cancer screening: The costs and benefits of getting to 80% in every community

“…Currently, more than 15 million Medicaid beneficiaries are age‐eligible for CRC screening, and the majority are not current (47% in 2015) 17 or have never received CRC screening. Over 75% of CRC deaths are attributed to not being up to date for screening 18 . Including CRC screening in the core list of performance measures could motivate Medicaid health plans to implement evidence‐based programs to increase screening rates, especially if the measures were tied to incentives.…”