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. 2021 Jun;38(6):270-275.
doi: 10.12788/fp.0142.

High Rate of Inappropriate Fecal Immunochemical Testing at a Large Veterans Affairs Health Care System

Adam B Gluskin  1 , Jeffrey M Dueker  1 , Asif Khalid  1
Affiliations

High Rate of Inappropriate Fecal Immunochemical Testing at a Large Veterans Affairs Health Care System

Adam B Gluskin et al. Fed Pract. 2021 Jun.

Abstract

Introduction: Colonoscopies and fecal immunochemical tests (FITs) are the preferred modalities for colorectal cancer (CRC) screening. In addition to proper patient selection, appropriate fecal immunochemical testing requires that negative tests be repeated annually, positive tests lead to a diagnostic colonoscopy, and FIT not be performed within 5 years of a colonoscopy with adequate bowel preparation. We sought to study the frequency of inappropriate FITs at the Veterans Affairs Pittsburgh Health Care System in Pennsylvania.

Methods: A retrospective quality assurance study was undertaken of veterans undergoing FIT in a 3-year period (2015-2017). We calculated the rate of a negative initial FIT in 2015/2016 followed by a second FIT in 2016/2017 in a random selection of veterans (3% SE, 95% CI). Demographics were compared in an equal random number of veterans that did and did not have a follow-up FIT (5% SE, 95% CI of all negative FIT). We also calculated the rate of completing colonoscopy following a positive FIT in a random selection of veterans (3% SE, 95% CI). Finally, we investigated use of FIT following a colonoscopy for all veterans in the study period.

Results: A total of 6,766 FITs were performed; 4,391 unique veterans had at least 1 negative FIT, and 709 unique veterans had a positive FIT. Of 1,742 veterans with at least 1 negative FIT, 870 were eligible for repeat testing during the study period, and only 543 (62.4%) underwent at least 2 FITs. There was no significant demographic difference in veterans that had only 1 or at least 2 FITs. Of 410 veterans with a positive FIT, 113 (27.5%) did not undergo a subsequent colonoscopy within 1 year due to patient refusal, or failure to schedule or keep a colonoscopy appointment. Of 832 veterans who had both a FIT and colonoscopy in the interval, 108 veterans underwent colonoscopy with a subsequent FIT (1.6% of total FITs performed). Of these, 95 (88%) were judged to be inappropriate. Thirteen instances of FIT following colonoscopy were appropriate based on patient preference to undergo fecal immunochemical testing for CRC screening modality after undergoing colonoscopy with an inadequate bowel preparation.

Conclusions: Veterans underwent inappropriate testing due to failure to undergo serial FIT after a negative result (37.6%), failure to complete colonoscopy following a positive FIT (27.5%), and undergoing inappropriate FIT following a recent colonoscopy (88%). Efforts are still required to improve both patient and provider education and adherence to appropriate fecal immunochemical testing and CRC screening guidelines.

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Conflict of interest statement

Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.

Figures

FIGURE
FIGURE
Flowchart of Veterans Undergoing FIT Abbreviation: FIT, fecal immunochemical test.
See this image and copyright information in PMC

References

    1. Preventive Services US, Force Task, Bibbins-Domingo K, Grossman DC, et al. Screening for Colorectal Cancer: US Preventive Services Task Force recommendation statement [published correction appears in JAMA 2016 Aug 2; 316 (5):545] [published correction appears in JAMA 2017 Jun 6; 317(21):2239] JAMA. 2016;315(23):2564–2575. doi: 10.1001/jama.2016.5989. - DOI - PubMed
    1. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;153(1):307–323. doi: 10.1053/j.gastro.2017.05.013. - DOI - PubMed
    1. Lee YC, Li-Sheng Chen S, Ming-Fang Yen A, et al. Association between colorectal cancer mortality and gradient fecal hemoglobin concentration in colonoscopy noncompliers. J Natl Cancer Inst. 2017;109(5):djw269. doi: 10.1093/jnci/djw269. - DOI - PMC - PubMed
    1. Corley DA, Jensen CD, Quinn VP, et al. Association between time to colonoscopy after a positive fecal test result and risk of colorectal cancer and cancer stage at diagnosis. JAMA. 2017;317(16):1631–1641. doi: 10.1001/jama.2017.3634. - DOI - PMC - PubMed
    1. Gellad ZF, Almirall D, Provenzale D, Fisher DA. Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia. Dig Dis Sci. 2009;54(11):2497–2502. doi: 10.1007/s10620-008-0653-8. - DOI - PMC - PubMed