Fecal Occult Blood Test Rates Research Articles

Feasibility of Support by Family Practitioners in Reducing Colorectal Cancer-Related Death among Outpatients Who Have Not Undergone Colorectal Cancer Screening.

We aimed to clarify the effectiveness of interventions in outpatients who did not undergo colorectal cancer (CRC) screening. From September 2012 to August 2013, we conducted a project, which showed that the immunological fecal occult blood test (FOBT) was actively recommended for outpatients who were ≥40 years of age, attended the Marumori Hospital regularly, and were not screened for CRC in the previous two years. We evaluated the detection rate of CRC and the disease specific survival ratio in February 2021 among patients with positive FOBT results during the retrospective cohort study. Overall, 388 (91%) out of the 425 outpatients submitted their stool samples. Among 388 outpatients, 66 tested positive for FOBT. While both the positive rate of FOBT and the detection rate of CRC (17% and 0.77%, respectively) were significantly higher than those in the nationwide administrative examination (5.7% and 0.13%, respectively) (p < 0.05), there was no statistically significant difference in the detection rate, compared with the group aged 65 years and older in the nationwide administrative examination. The 7-year CRC-specific survival ratio was 98.5%. Active promotion of FOBT at primary care institutions for outpatients who did not undergo CRC screening may contribute to reducing the frequency of CRC-related deaths.

Change in colorectal cancer (CRC) testing rates associated with the introduction of the first organized screening program in canton Uri, Switzerland: Evidence from insurance claims data analyses from 2010 to 2018

The first canton in Switzerland to implement an organized colorectal cancer screening program (OSP) was Uri. Starting in 2013, it offered 50–69-year-olds free testing with colonoscopy every 10 years or fecal occult blood test (FOBT) every 2 years. We tested the association between the OSP and testing rates over time.We analyzed claims data of 50–69-year-olds from Uri and neighboring cantons (NB) provided by a large health insurance and complemented it with data from the OSP. We fitted multivariate adjusted logistic regression models to compare overall testing rates and by method (colonoscopy or FOBT/both) We computed the 2018 rate of the population up-to-date with testing (colonoscopy within 9 years/FOBT within 2 years).Yearly overall testing rates in Uri increased from 8.7% in 2010 to 10.8% in 2018 and from 6.5% to 7.9% in NB. In Uri, the proportion tested with FOBT/both increased from 4.7% to 6.0% but decreased from 2.8% to 1.1% in NB. Testing by FOBT/both increased more between 2015 and 2018 than 2010–2012 in Uri than in NB (OR:2.1[95%CI:1.8–2.4]), it increased less for colonoscopy (OR:0.60[95%CI:0.51–0.70]), with no change in overall CRC testing (OR:0.91[95%CI:0.81–1.02]). In 2018 in Uri, 42.5% were up-to-date with testing (FOBT/both:9.2%, colonoscopy:35.7%); in NBs, 40.7% (FOBT/both:2.7%, colonoscopy:39%).Yearly FOBT rates in Uri were always higher than in NB. Though the OSP in Uri was not associated with a greater increase in overall testing rates, the OSP was associated with increased FOBT.

Regional and Racial Trends in US Colorectal Cancer Screening

Objective: Colorectal cancer screening is proven to reduce cancer burden and mortality. Despite several well-established screening methods, colorectal cancer still has the third-highest cancer mortality rate in the United States. Methods: We examine the self-reports of individuals ever having a colonoscopy or fecal occult blood test (FOBT) from the Behavioral Risk Factor Surveillance System questionnaire to determine if screening rates differed by race and year while controlling for state and other variables. Results: Colonoscopy rates increased between years while FOBT rates decreased. Blacks had higher colonoscopy rates than Whites and other racial minorities had lower rates. Blacks also had higher FOBT rates, as did American Indians/Alaska Natives (AI/ ANs), Native Hawaiian/Pacific Islanders (NH/PIs), and the multiracial category (MR). Whites and Asians saw a rise in colonoscopy rates between 2014 and 2018, whereas AI/ANs, NH/PIs, MR, and the other category (Other) saw a rise in FOBT rates. State-level screening rates were not associated with state-level incidence or mortality rates. Conclusions: Racial disparities still exist in self-reported colorectal screening patterns, though some are trending in the right direction, and there is a gap between screening rates and incidence rates by state that depend on further factors.

Association between colorectal cancer testing and insurance type: Evidence from the Swiss Health Interview Survey 2012.

Both colonoscopy and fecal occult blood test (FOBT) are commonly used for colorectal cancer (CRC) screening, but colonoscopy costs much more than FOBT. Swiss insurance offers high or low deductibles and choice of basic or private insurance. We hypothesized that high deductibles and basic insurance discourage colonoscopy, but do not change FOBT rates. We determined the proportion of patients tested for CRC in Switzerland (colonoscopy within 10years, FOBT within 2years), and determined associations with health insurance type. We extracted data on 50-75-year-olds from the Swiss Health Interview Surveys of 2012 to determine colonoscopy and FOBT testing rates (n=7335). Multivariate logistic regression models estimated prevalence ratios (PRs) of CRC testing associated with health insurance type (deductible and private insurance), adjusted for socio-demographic factors (age, gender, education, income) and self-rated health. The weighted proportion of individuals tested for CRC within recommended intervals was 39.5%. Testing with colonoscopy was significantly associated with private insurance (PR 1.85, 95% CI: 1.46-2.35) and low deductible (PR 2.00, 95% CI: 1.56-2.57). Testing with FOBT was significantly associated with deductible (PR 1.71, 95%CI:1.09-2.68) but not with private insurance. About 60% of the Swiss population was not current with CRC testing. After adjusting for covariates, private insurance and low deductible was significantly associated with higher prevalence of CRC testing, indicating that waiving the deductible could increase CRC screening uptake and reduce health inequality.

The expression and significance of feces cyclooxygensae-2 mRNA in colorectal cancer and colorectal adenomas.

Background/Aim:This study aims to explore the expression and significance of feces cyclooxygensae-2 (COX-2) mRNA in colorectal cancer and colorectal adenomas.Materials and Methods:The expression of feces COX-2 mRNA in colorectal cancer (n = 28), colorectal adenomas (n = 54), and normal control group (n = 11) were examined by reverse transcriptase polymerase chain reaction (RT-PCR). The positive rate of fecal occult blood test (FOBT) were detected in colorectal cancer (n = 30), colorectal adenomas (n = 56), and normal control group (n = 11); the sensitivity of the two methods was also compared.Results:The positive rate of feces COX-2 mRNA in colorectal cancer was 82.1% (25/28), which was significantly higher than colorectal adenomas 59.3% (32/54), and normal tissues 18.2% (2/11), the difference being significant between the three groups (χ2= 13.842, P = 0.001). The positive rate of FOBT in colorectal cancer was 73.3% (10/30), which was significantly higher than colorectal adenomas 10.7% (6/56) and normal tissues 9.1% (1/11), the difference being significant between these three groups (χ2= 7.525, P = 0.023). There was no significant association between feces COX-2 expression and various clinical pathological features of colorectal cancer and colorectal adenomas (P > 0.05). The sensitivity of the RT-PCR method is higher than FOBT, however, the specificity of FOBT is slightly higher than RT-PCR.Conclusions:High expression of feces COX-2 mRNA in colorectal adenomas and colorectal cancer is a common event; it is an early event in the development of colorectal adenomas to colorectal cancer. Feces COX-2 mRNA has a high sensitivity for detect colorectal cancer; combination with FOBT will be the best alternative. Feces COX-2 can be potentially used in the early diagnosis and screening of colorectal cancer.

Third Annual Fecal Occult Blood Testing in Community Health Clinics.

Our objective was to determine the effectiveness of 3 approaches to encourage completion of fecal occult blood testing (FOBT) in the third year of the intervention. Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Clinics were randomly assigned to enhanced care (screening recommendation and FOBT kit mailed annually), education (patients additionally received a health literacy appropriate pamphlet and simplified FOBT instructions), or nurse support (same as education but with nurse follow-up). Participants included 206 patients with negative FOBTs in years 1 and 2; ages 50-85, 80% female, 70% African American, and 52% had limited health literacy. The main outcome measure was completion of a third annual FOBT. Third-year FOBT rates were 48% overall, 34.2% enhanced care, 59.6% education, and 47.4% nurse support (p = .21), even after adjustment for sex, marital status, and health literacy. All mailed interventions were similarly effective in sustaining rates of FOBT screening. Post hoc analyses of the results analyzed by health literacy skills found that patients with both limited and adequate health literacy skills were more likely to complete FOBTs when mailed simplified instructions.

The effect of test kit provision, and individual and family education on the uptake rates of fecal occult blood test in an Asian population: a randomized controlled trial.

The purpose of the study was to investigate whether fecal occult blood test (FOBT) home-delivery and individual education or combined with family education increases FOBT uptake rates in Singapore. This is a randomized controlled intervention study of Singaporean residents aged 50 years and above, conducted in May 2012 till May 2013. Eligible individuals in randomly selected households were screened, and one member was randomly selected and allocated to one of the four arms: Group A (individual and family education, FOBT kits provided), Group B (individual education only, FOBT kits provided), Group C (no education, FOBT kits provided) and Group D (no education or FOBT kits provided). Overall response rate was 74.7 %. The FOBT return rates for groups A, B, C and D were 24.5 % [CI 16.2-34.4 %], 25.3 % [CI 16.4-36.0 %], 10.7 % [CI 4.7-19.9 %] and 2.2 % [CI 0.3-7.7 %], respectively. Respondents who were provided education and home-delivered FOBT kits were 15 times more likely to return FOBT kits [Group A: OR 15.0 (3.4-66.2); Group B: OR 15.5 (3.5-68.8)] and those provided with home-delivered FOBT without education were five times more likely to return FOBT kits [Group C: OR 5.8 (1.2-28.3)] than those without education and FOBT kits (Group D). There was no significant difference in return of FOBT kits whether education was provided to subject with or without a family member. Home delivery of FOBT kits increased FOBT return rates and individual education combined with home-delivered FOBT increased FOBT return rates even further. However, additional combination with family education did not increase FOBT rates further.

Strategies to improve repeat fecal occult blood testing cancer screening.

A comparative effectiveness intervention by this team improved initial fecal occult blood testing (FOBT) rates from 3% to 53% among community clinic patients. The purpose of this study was to evaluate the effectiveness and costs associated with a literacy-informed intervention on repeat FOBT testing. Between 2008 and 2011, a three-arm quasi-experiential comparative effectiveness evaluation was conducted in eight community clinics in Louisiana. Clinics were randomly assigned to receive: enhanced care, a screening recommendation, and FOBT kit annually; a brief educational intervention where patients additionally received a literacy appropriate pamphlet and simplified FOBT instructions; or nurse support where a nurse manager provided the education and followed up with phone support. In year 2, all materials were mailed. The study consisted of 461 patients, ages 50 to 85 years, with a negative initial FOBT. Repeat FOBT rates were 38% enhanced care, 33% education, and 59% with nurse support (P = 0.017). After adjusting for age, race, gender, and literacy, patients receiving nurse support were 1.46 times more likely to complete repeat FOBT screening than those receiving education [95% confidence interval (CI), 1.14-1.06; P = 0.002] and 1.45 times more likely than those in enhanced care but this was not significant (95% CI, 0.93-2.26; P = 0.10). The incremental cost per additional person screened was $2,450 for nurse over enhanced care. A mailed pamphlet and FOBT with simplified instructions did not improve annual screening. Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT, yet this may be too costly for community clinics.

Abstract B96: Trends in colorectal cancer screening with home-based fecal occult blood test (FOBT) in adults aged 50–64 years, 2000–2008

Abstract Introduction: Screening for colorectal cancer (CRC) in asymptomatic average risk populations reduces CRC incidence and mortality. Annual home-based fecal occult blood testing (FOBT) has been recommended as a CRC screening modality in average-risk adults aged 50 and older. National surveys have reported declines in FOBT screening rates in the last decade, but it is unknown whether these declines have extended across all socioeconomic status (SES) and racial/ethnic groups, and the changes relative to endoscopic screening have not been evaluated. Methods: Data on respondents aged 50–64 years were from the Cancer Control Module administered to sampled adults National Health Interview Surveys in 2000, 2005, and 2008. Weighted analyses and multivariate logistic regression were used to study trends in the use of home FOBT testing in the past year and endoscopic test in the past 10 years. Results: Overall, the prevalence of home FOBT in the past year declined 5.9% points (95% CI: 4.5%, 7.3%) between 2000 and 2008. SES differences in trends were observed wherein significant declines were restricted to higher-SES groups (those with private and military insurance, those with a usual source of care, those with a high school degree or higher, those classified as not poor, those born in the US), whereas lower-SES (uninsured and the publicly-insured, those without a usual source of care, those with less than a high school education, the poor and the near poor, and immigrants to the US) did not experience significant changes in FOBT prevalence during this time period. FOBT rates in Hispanics did not change significantly during this time, whereas non-Hispanic whites and non-Hispanic blacks experienced significant declines. Coincident with declines in FOBT prevalence during this time, endoscopic screening prevalence increased consistently in higher-SES groups. Fewer lower-SES groups experienced increases in endoscopic screening prevalence, with most increases being of a lower magnitude than in the higher-SES subgroups. Conclusions: Socially and economically disadvantaged groups experienced little or no change in FOBT rates from 2000 to 2008. There has been a significant shift from FOBT to endoscopic screening in higher-SES and a few lower-SES groups, but the extent of this shift in lower-SES groups appeared to be smaller than in higher-SES groups. Programs promoting annual screening with high-sensitivity guaiac-based or immunochemical FOBT represent an appropriate and low cost alternative to colonosopy screening, provided that these programs consider patient- and physician attitudes, knowledge and preferences, and systems-issues related to referral, adherence, test quality assurance, and adequate follow-up of positive test results. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B96.

Two-year Trends in Colorectal Cancer Screening After Switch to a High-deductible Health Plan

Recent health reform laws might accelerate high-deductible health plan (HDHP) growth. The impact of HDHPs on long-term colorectal cancer screening rates and low socioeconomic status (SES) members is unknown. We studied colorectal cancer screening rates among 1306 Health Maintenance Organization (HMO) members for 1 year before and 2 years after an employer-mandated switch to HDHPs, compared with 1306 propensity score-matched controls who remained in HMOs by employer choice. HDHP members had full coverage of fecal occult blood testing (FOBT) but colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema were subject to $500 to $2000 annual deductibles. HMO members had full coverage of these tests. We used generalized estimating equations to adjust screening rates for member characteristics. We stratified analyses by SES. Overall colorectal cancer screening rates in the HDHP group relative to the control group trended down from baseline to the first and second follow-up years [ratios of change, 0.88, (95% confidence interval, 0.73 to 1.06) and 0.83, (0.69 to 1.00), respectively]. Low SES HDHP members experienced a statistically significant relative decrease in colonoscopy in both follow-up years [0.65, (0.48 to 0.88) and 0.59, (0.42 to 0.84), respectively] and a trend toward increased FOBT [1.26, (0.92 to 1.72) and 1.30, (0.95 to 1.77), respectively] to maintain stable overall colorectal cancer screening rates [1.01, (0.77 to 1.32) and 0.93, (0.71 to 1.22), respectively]. High SES members experienced less pronounced decrease in colonoscopy [0.89, (0.67 to 1.18) and 0.87, (0.62 to 1.21), respectively] but FOBT rates did not increase [0.83, (0.62 to 1.11 and 0.81), (0.60 to 1.11), respectively]. Switching to a HDHP was associated with a downward trend in overall colorectal cancer screening rates after 2 years. Low SES HDHP members maintained stable rates, but substituted FOBT for colonoscopy and other tests now more widely recommended. Further research should investigate whether such reduced adherence to screening guidelines adversely affects health outcomes.

Socioeconomic and Racial Patterns of Colorectal Cancer Screening among Medicare Enrollees in 2000 to 2005

Lower rates of screening among minorities and low-income populations contribute to colorectal cancer health disparities. Therefore, we examined patterns of colorectal cancer screening and associations with race-ethnicity, education, and income over time. Repeated cross-sectional data from the Medicare Current Beneficiary Survey of noninstitutionalized colorectal cancer-free Medicare enrollees ages 65 to 80 years interviewed in 2000 (n = 8,355), 2003 (n = 7,922), and 2005 (n = 7,646). We examined rates of colonoscopy/sigmoidoscopy use within 5 years (recent endoscopy), colonoscopy/sigmoidoscopy use >5 years previously, or fecal occult blood test (FOBT) within 2 years. Among those included in the analyses, there was a steady increase in recent endoscopy rates and decrease in FOBT use over the 6-year period among all racial, educational, and income groups. During each of the survey years, those less educated or in lower-income groups were less likely to undergo colorectal cancer screening in a dose-response fashion. In multinomial regression analyses that adjusted for factors including health insurance, there were no significant differences in recent endoscopy or FOBT rates between Blacks or Hispanics and Whites, but differences by education and income remained. Compared with those in higher-income group, lower-income enrollees had lower rates of screening, and differences by income were larger for enrollees residing in metropolitan areas. Among Medicare beneficiaries, there are persistent colorectal cancer screening disparities due to a complex combination of socioeconomic disadvantages from lower education and income, place of residence, and inadequate insurance. However, insurance alone does not eliminate socioeconomic differences in colorectal cancer screening.

Single Immunochemical Fecal Occult Blood Test for Detection of Colorectal Neoplasia

This study was designed to investigate the validity of a single immunochemical fecal occult blood test (FOBT) for detection of colorectal neoplasia. A total of 3,794 average-risk screenees and 304 colorectal cancer patients admitted to the National Cancer Center, Korea, between May 2001 and November 2002, were studied prospectively. All screenees and admitted patients underwent FOBT and total colonoscopic examinations. Stools were self-collected, and examined using an immunochemical fecal occult blood test (OC-hemodia, Eiken Chemical Co. Tokyo, Japan) and an OC-sensor analyzer(R) (Eiken Chemical Co. Tokyo, Japan). Of the 3,794 asymptomatic screenees, the colonoscopy identified colorectal adenomas and cancers in 613 (16.2%) and 12 (0.3%) subjects, respectively. The sensitivities of a single immunochemical FOBT for detecting colorectal cancers and adenomas in screenees were 25.0 and 2.4%, respectively. The false positive rate of FOBT for colorectal cancer in screenees was 1.19%. For the total 316 colorectal cancer cases (including 12 cases from screenees), the FOBT sensitivities according to the T-stage were 38.5, 75.0%, 78.9 and 79.2% for T1, 2, 3 and 4 cancers, respectively. The sensitivities according to the Dukes stages A, B and C were 63.4, 79.3 and 78.6%, respectively. The sensitivities of a single immunochemical FOBT for detecting colorectal cancers and adenomas in screenees were 25.0 and 2.4%, respectively. The sensitivities of FOBT were about 80% for Dukes B or C colorectal cancers and 63.4% for Dukes A.

The effect of comorbid illness on receipt of cancer screening by older people.

To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986. Piedmont area of North Carolina. Two thousand two hundred twenty-five subjects with a mean age of 79 who responded in 1992. Self-reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey. Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32-0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54-0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18-2.07), Pap smear (OR = 1.41, 95% CI = 1.09-1.83), and FOBT (OR = 1.37, 95% CI = 1.12-1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98-1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06-1.71), breast examination (OR = 1.46, 95% CI = 1.12-1.89), and Pap smear (OR = 1.31, 95% CI = 1.04-1.65). With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.

Fecal Occult Blood Test Use by Kansas Medicare Beneficiaries

Purpose. The aim of this study was to examine utilization of and trends in fecal occult blood testing (FOBT) among beneficiaries since Medicare began FOBT coverage on January 1, 1998.Methods. We identified Kansas Medicare beneficiaries ages 65–79. Using Medicare claims, we determined which beneficiaries received FOBT during 1998–1999. We examined demographic variables associated with FOBT and rate changes over time. We linked beneficiaries to primary care practices (PCPs) and examined FOBT variations among 483 PCPs.Results. FOBT use remained unchanged during the study period. Of the 215,322 beneficiaries, 11% received at least one FOBT in 1998 and 11% in 1999; 18% had at least one test during the 2-year period, but only 4% had a test during both years. Caucasians and females had the highest FOBT rates. Although FOBT rates among PCPs ranged from 0 to 71%, only 19% of the practice rates exceeded 10%.Conclusions. Few beneficiaries obtain annual FOBT and little change in rates has occurred since Medicare reimbursement began. Although FOBT rates vary widely between PCPs, most either do not provide FOBT or do not bill Medicare for FOBT. The FOBT claims rate is much lower than reported in patient surveys and may indicate that Medicare should reexamine its reimbursement policy.

Fecal Occult Blood Screening for Colorectal Cancer

Annual fecal occult blood test (FOBT) screening using rehydrated Hemoccult slides has been reported in the Minnesota Colon Cancer Control Study to reduce colorectal cancer mortality by about 33%. However, some of the benefit of FOBT screening may come from "chance" selection of persons for colonoscopic examination because of the high positivity rate of FOBT (about 10%) that may occur for reasons other than a bleeding cancer or polyp. To determine how much this mechanism could account for the benefit of FOBT screening, we used a simple mathematical model to simulate the course of a cohort of screened persons, incorporating published data including those from the Minnesota study. The results suggest that one third to one half of the mortality reduction observed from FOBT screening in the Minnesota study may be attributable to chance selection for colonoscopy. We conclude that annual FOBT screening with rehydration is a haphazard method for selecting persons for colonoscopy.