Recommendation of Colorectal Cancer Screening Impacts Adherence in Diverse Populations

Although colonoscopy is stressed as the preferred screening test for colorectal cancer, researchers from the University of California, San Francisco found that recommending colonoscopy resulted in lower adherence compared with fecal occult blood test or a choice of the two procedures in diverse populations, according to a Digestive Disease Week news release.

Researchers compared single and multiple recommendations for CRC screening in a racially diverse population. About 1,000 patients at average risk for CRC were randomly assigned to receive a recommendation by their primary care provider for FOBT, colonoscopy or a choice of the two, according to the release. Patients completed a survey of recommended tests as well as those they actually adhered to in the following year, and complete follow-up was achieved in 99 percent of the patients.

"The unique aspect of our study was the ability to identify differences in adherence to screening based on the method of recommendation, and whether these varied between different racial and ethnic groups," John M. Inadomi, MD, professor of medicine at UCSF and chief of clinical gastroenterology at San Francisco General Hospital, said in the release.

Overall, 65.1 percent of patients adhered to screening, but there were differences among the groups: 38 percent of patients recommended for colonoscopy alone underwent this screening, 67 percent recommended for FOBT alone returned the test and 70 percent who were given a choice between colonoscopy or FOBT adhered to either screening strategy, according to the release. Even when accounting for adherence to FOBT among patients who were recommended colonoscopy only, the combined adherence to either test (58 percent) remained significantly lower compared with the groups who were recommended FOBT alone or provided a choice.

Researchers also ensured that the recommended colonoscopy could be done within two weeks of scheduling and that the cost was not borne by the patient. They also provided patients with a ride to receive the screening, and patients were given instructions for the prep and the procedure in their preferred language. Despite these interventions, adherence to colonoscopy remained low, according to the release.

Dr. Inadomi cautioned that researchers looked only at the first episode of screening and that further research is being conducted to determine whether these findings are consistent when adherence to programmatic screening, as is required for FOBT, is evaluated.

Read the DDW release about adherence in colonoscopy.