Follow-up of Screening Results Varies Between Breast, Cervical, and Colorectal Cancers

Follow-up of people whose screening examinations showed abnormal findings occurred faster for breast cancer than for colorectal and cervical cancers, according to a recent study involving more than 1 million people who underwent screening for these cancers. The study, published in the Journal of General Internal Medicine (doi:10.1007/s11606-015-3552-7), reported the percentages of people with abnormal findings on screening examination receiving timely follow-up were 93.2% to 96.7% of women across breast centers, 46.8% to 68.7% of patients across colorectal centers, and 46.6% of women at the cervical center.

The study characterized variations in cancer screening practice across 7 centers participating in the National Cancer Institute sponsored PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium. Cancer screening abnormality rates and their timely follow-up were examined across the centers and among primary care practices within centers.

The study's authors called the variation in timely follow-up of abnormal findings on screening concerning and cited several factors that could contribute to the varying follow-up times, including the underlying complexity of coordinating the next steps in clinical care, differences in the severity of abnormalities detected, and the type of follow-up required.

For example, lower follow-up rates for colorectal cancer screening may be due to a perceived inconvenience and the invasive nature of the procedure involved. Patients undergoing colonoscopy typically need to take time off work, which may pose a barrier, especially for lower-income patients.

Furthermore, federal policies and regulations that encourage timely cancer screening may have a greater impact on screening follow-up than individual patient and health system factors. Such policies exist for breast and cervical cancer screening, but are nonexistent for colorectal cancer screening.

"The documented variation in follow-up of abnormal cancer screening tests across centers and primary care practices highlights opportunities for improving cancer screening," said Anna Tosteson, ScD, the James J. Carroll Professor of Oncology at the Geisel School of Medicine and a faculty member at The Dartmouth Institute for Health Policy & Clinical Practice in Lebanon, New Hampshire. Tosteson, lead investigator of the study, noted that this is the first PROSPR study to make cross-organ comparisons in screening outcomes.

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