Lack of Follow-Up After Fecal Occult Blood Testing in Older Adults

Inappropriate Screening or Failure to Follow Up?

Current practices may be leading to too much screening for colorectal cancer in older patients and poor efforts to determine and prompt appropriate follow-up testing, according to this novel study.

The Fecal Occult Blood Test (FOBT) is a low-risk screening test for colorectal cancer. This prospective study looked at 2,410 patients, 70 years or older and without significant colon issues, who were screened with FOBT at four Veterans Affairs (VA) medical centers during 2001. But unlike previous research, this study looked beyond VA records to Medicare and medical records to detect follow-up testing within one year post-FOBT. Patients are screened with three FOBT cards: a test is considered positive if any cards are positive; negative if all three cards are clear; and incomplete if fewer than three cards are submitted and all are negative.

Key Findings:

  • Of the 212 patients with positive FOBTs, 42 percent received a full colon examination within one year. Of the 83 patients with incomplete tests, 33 percent received any follow-up within a year. By comparison, 29 percent of the 2,091 patients who tested negative received some sort of colorectal testing in the year.
  • There were no significant age-based, comorbidity, racial/ethnic or socioeconomic characteristics associated with follow-up within a year after a positive test.
  • The incidence of complete evaluation after a positive test was associated with the VA site; how many FOBT cards were positive; and the number of VA outpatient visits.
  • For 43 percent of the 122 patients who tested positive but did not receive a complete evaluation, there was no acknowledgement of the positive test in VA records.
  • Of those who tested positive but never had follow-up testing, 38 percent should probably never have been screened in the first place.

The authors conclude quality improvement initiatives are needed to prompt more individualized decision-making regarding screening and follow-up testing for colorectal cancer in older patients.