Longitudinal Adherence With Stool-Based Testing for Colorectal Cancer Screening in Four United States Health Systems

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BACKGROUND & AIMS: Longitudinal adherence with annual stool-based screening for colorectal cancer is guideline-recommended. This paper assessed patterns and predictors of repeat stool-based screening over time and associated outcomes. METHODS: This retrospective cohort study followed adults aged 50 to 65 years in 4 health systems eligible for repeat screening following a negative index fecal immunochemical test or guaiac fecal occult blood test in 2010 to 2011 for up to 10 years. Repeat stool-based testing patterns were categorized as: consistent (≥75% of rounds completed, inconsistent [<75%], and never repeaters. Multivariable predictors of consistent testing were analyzed, as well as associations between screening consistency and cancer stage at diagnosis. RESULTS: , public insurance, prior stool-based testing, and a primary care provider visit in the past year. Advanced stage colorectal cancer was more frequent among never-repeaters (19% vs 12% for inconsistent and 12% consistent repeaters). Early-stage cancer was more common among consistent repeaters (56% vs 49% inconsistent and 44% never-repeaters). CONCLUSIONS: Among patients initially screened with an annual stool-based test, about one-half (54%) consistently repeated it, and 16% never repeated during available follow-up. The health system where the patient was cared for was most strongly associated with consistent stool-based testing, and higher adherence was associated with earlier cancer stage at diagnosis.

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