The time between a positive fecal blood test result for colon cancer screening and a follow-up colonoscopy varies widely across the United States, according to a recent study published in Cancer Epidemiology, Biomarkers and Prevention.1

Fecal blood tests are a generally accepted strategy for colorectal cancer screening. After positive results, patients are usually referred for a follow-up colonoscopy.

This study evaluated data from 62 384 patients with positive fecal blood test results. The data spanned 4 health care systems within the Population-Based Research Optimizing Screening through Personalized Regimes consortium. All patients were 50 to 89 years with positive results between January 2011 and December 2012.

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Although most patients received a follow-up colonoscopy within 6 months of a positive result on fecal blood test, follow-up rates varied significantly across the health care systems. Median days to colonoscopy were 41, 47, 84, and 174 days across the 4 health care systems analyzed.

By 12 months, 58.1% to 83.8% of patients had received a follow-up colonoscopy, and the differences again correlated with the health care system. Higher comorbidity scores and increased age were both correlated with lower follow-up rates.

“It is important for providers or health care systems to know that if a patient hasn’t received a colonoscopy within 6 months of a positive fecal blood test, they are unlikely to in the future, at least not without some further intervention,” said Jessica Chubak, PhD, an associate investigator with Group Health Research Institute in Seattle, Washington, and lead author of the study.

“Understanding the variability in follow-up colonoscopy after a positive fecal blood test may help health care providers and systems identify patients in need of targeted interventions to complete follow-up.”

While this study suggested a need to improve follow-up for positive colorectal cancer screening results, it did not assess whether delays in colonoscopies were associated with increased colorectal cancer mortality.

The National Cancer Institute funded this study.


1. Chubak J, Garcia MP, Burnett-Hartman AN, et al; on behalf of the PROSPR consortium. Time to colonoscopy after positive fecal blood test in four U.S. health care systems [published online ahead of print February 4, 2016]. Cancer Epidemiol Biomarkers Prev. 2016;25:344.