1419PD - Colorectal cancer screening: factors associated with not undergoing an early colonoscopy after a positive fecal occult blood test

Date 01 October 2012
Event ESMO Congress 2012
Session Public health and familial cancer
Topics Cancer Aetiology, Epidemiology, Prevention
Colon Cancer
Rectal Cancer
Presenter emilie Ferrat
Authors E. Ferrat1, J. Lebreton2, S. Bercier3, K. Veerabudun2, Z. Brixi3, E. Paillaud4, C. Attali5, S. Bastuji-Garin2
  • 1Centro De Oncologia, University of medicine, 9400 - Créteil/FR
  • 2Laboratoire D'investigation Clinique (lic Ea4393), University of medicine, 9400 - Créteil/FR
  • 3Adoc94, association of organized cancer screening, 94340 - Joinville-le-pont/FR
  • 4Ucog, hôpital Henri-Mondor, 94000 - Créteil/FR
  • 5General Practice, université Paris-Est(UPEC), 94100 - Créteil/FR

Abstract

Background

Current screening guidelines recommend a complete colon evaluation with colonoscopy after a positive fecal occult blood test (FOBT). However, no timing guidelines are provided. A recent study showed that delay from FOBT to colonoscopy was associated with an increased risk of neoplasia. Our aim was to identify individual and contextual predictors of not undergoing an early colonoscopy after a positive FOBT.

Methods

All average-risk residents of a French county who have had a positive FOBT from June 2007 to December 2010 (n = 2369) during organized colorectal cancer (CRC) screening campaigns were included. Individual data were abstracted from the Organized Cancer Screening Association database and aggregated socioeconomic data (physician density, Townsend deprivation index) from the National Institute of Statistics and Economic Studies database. Multilevel and multinomial logistic regression analyses were performed to assess predictors of delayed colonoscopy (> median delay, 58 days), no colonoscopy and no response to cancer screening program after one year. Early colonoscopy was the reference category.

Results

The rate of colonoscopy was 86.9%. 1 037 patients (45.3%) had an early, and 1 021 (44.6%) a delayed colonoscopy, 106 (4.7%) did not perform colonoscopy and 123 (5.4%) were nonrespondents. The multilevel analysis displayed a significant (p < 0.05) inter-area variation for not undergoing an early colonoscopy. In multivariate analysis, a delayed colonoscopy was associated with a first screening test (OR 1.61; 95% CI: 1.16-2.25). Not undergoing a colonoscopy and non response were associated with a FOBT received at home rather than given by the general practitioner (GP) (OR 1.94; 95%CI: 1.25-3.01 and OR = 2.74; 95%CI: 1.78-4.21, respectively) and living in the most deprived areas (OR 2.29; 95% CI: 1.20-4.37 and OR = 4.37; 95%CI: 2.23-8.55 respectively). There was no significant association between physician density, gender, age and follow-up after a positive FOBT.

Conclusion

Actions to improve follow-up after a positive FOBT should focus on first CRC screening and population living in the most deprived areas. This study emphasizes the role of GPs in CRC screening.

Disclosure

All authors have declared no conflicts of interest.