Fight CRC medical experts Fola May, MD PhD (Board of Directors, Medical Advisory Board, Health Equity Committee), Samir Gupta, MD MSCS (Medical Advisory Board, Early Age Onset Workgroup), Joshua Demb, PhD, MPH (Early-Age Onset Workgroup), along with colleagues Yazmin San Miguel, MPH and Maria Elena Martinez, PhD have published the results of their recent study in Gastroenterology, titled “Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality.”
This study of 204,733 US Veterans aged 50-75 examined the association between the time to complete a follow-up colonoscopy after receiving a positive stool-based colorectal cancer (CRC) screening test and patient outcomes.
Stool-based CRC methods, including FIT, FOBT, and FIT-DNA, detect blood in the stool that cannot be seen with the naked eye. These types of tests can be completed at home and are an option for individuals at average risk without a family or personal history of CRC or certain bowel diseases. However, it is essential that those who receive an abnormal result complete a follow-up colonoscopy in order to complete the screening process.
The results of the study found that patients receiving care through the Veteran Affairs (VA) healthcare system with an abnormal stool-based test who delayed completion of a follow-up colonoscopy were more likely to be diagnosed with colorectal cancer, be diagnosed at an advanced stage, and subsequently die from the disease.
“It is essential for everyone to get screened for colorectal cancer. And noninvasive screening tests like stool-based screening tests help us screen more people. But it is critical that patients with an abnormal stool-based screening test result undergo follow-up with colonoscopy. That is the only way that we can find cancers early and prevent deaths from this disease.”
– Fola May, MD, PhD; Fight CRC Board of Directors, Medical Advisory Board, Health Equity Committee
Stool-based screening tests have been increasingly utilized as a strategy to increase equitable access to CRC screening during the COVID-19 pandemic and among underserved communities. Additionally, the recommended screening age for average-risk individuals was lowered from 50 to 45 by the American Cancer Society in 2018 and new draft guidelines from the USPSTF released in 2020 would also recommend starting screening at age 45 once finalized. By lowering the screening age to age 45, approximately 19 million additional Americans would be eligible for colorectal cancer screening and in need of access to CRC screening tests.
Patient education tailored to specific populations will be a key ingredient to increasing awareness of the importance of following up abnormal stool-based tests with colonoscopy.
“As a veteran, I can’t stress enough the importance of a timely colonoscopy after taking a FIT/FOBT test, especially for individuals under the age of 50. At age 45, it literally saved my life and prevented a stage IV diagnosis of colorectal cancer, which could have meant a less than 50% survival rate. The research being done is extremely important and vital for early prevention, detection, diagnosis, and treatment of colorectal cancer. I’ve personally benefited from such research and I’m celebrating 10 years later as a survivor.”
– Wenora Johnson, stage IIIB colorectal cancer survivor and Navy Veteran
The study also highlighted a current lack of national policy or standards for an acceptable time interval between an abnormal stool-based test result and follow-up colonoscopy. The authors hope the findings of this study will inform the establishment of standardized follow-up intervals and management recommendations at the national level and strategies to reduce barriers that patients face to completing a follow-up colonoscopy.
Fight Colorectal Cancer is currently working to advance policy at the state level to remove out-of-pocket costs for patients needing a colonoscopy following a positive non-invasive colorectal cancer screening test through our Catalyst State-by-State Advocacy Program. This study is a great complement to our work at the state level, as it highlights how harmful it can be when patients delay completing a follow up colonoscopy because of out-of-pocket costs or other factors.
Curious to learn more about colorectal cancer screening? Fight CRC’s Screening Mini Mag includes tips from medical professionals, cancer survivors, and others who have been screened. This is a great resource for anyone on the fence about preventive screening, or for anyone preparing for their screening.