Follow-Up Colonoscopies Low After Blood-Based Screening
Blood-Based colorectal Cancer screening: follow-Up Colonoscopy Rates Remain a Concern
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New research highlights a notable gap in the colorectal cancer screening pathway: while blood-based tests show promise, completion of the crucial follow-up colonoscopy remains low, possibly undermining their effectiveness. The study, published recently, analyzed national claims data and revealed that follow-up colonoscopy rates after a positive blood-based screening test were considerably lower than those following abnormal stool-based tests.
Lower Colonoscopy rates After Blood-Based Screening
Researchers found that only 27.9% of individuals with a positive blood-based screening test underwent a follow-up colonoscopy within a year. This contrasts sharply with the 63.7% rate observed among those with abnormal stool-based tests. the study utilized data from a large, diverse population, providing valuable real-world insights into the challenges of implementing blood-based screening.
“Blood-based colorectal cancer screening is promising, but it only works if individuals complete the follow-up colonoscopy,” said Folasade P. May, MD, senior author of the study and an associate professor of medicine at the David Geffen School of Medicine at UCLA, in a press statement. “More efforts are needed to help patients follow through to actually diagnose and treat the disease.”
The lower follow-up rate for blood-based tests might potentially be due to several factors. The authors noted that some colonoscopies performed after positive blood-based tests may not have been captured in the claims data,as they may have been scheduled but not yet billed. “As a result,our observed follow-up colonoscopy rate may underestimate the true follow-up rate,” they said. Though, the use of closed claims likely ensured reliable colonoscopy data overall.
Improving Follow-Up: A Multi-Pronged Approach
Experts emphasize the need for improved systems to track patients through the entire screening process, from initial test to diagnostic colonoscopy. A proposed colorectal cancer screening completion measure aims to complement the existing Healthcare Effectiveness Data and facts Set (HEDIS) measure. this new measure would specifically track patients with abnormal noninvasive tests to ensure they receive a follow-up colonoscopy within a recommended timeframe.”Having a metric will also encourage health systems to implement interventions to increase follow-up rates and help shift the focus from screening alone to the full continuum of care,” explained study author Zaki.
Effective strategies for boosting follow-up rates include multifaceted interventions incorporating patient navigation, reminder systems, and strong clinician recommendations.
Theodore R. Levin, MD, a research scientist at the Kaiser Permanente Division of Research and a gastroenterologist with Kaiser Permanente, Oakland, California, agreed that the findings are concerning but not surprising. “In the absence of a formal process to track patients with a positive stool-based screening test, we typically find fewer than half of people with a positive stool test go on to get a colonoscopy,” he said. “I would expect the numbers to be even lower for blood-based screening tests because this is a group that is likely to be less willing to have a colonoscopy.”
Physician and Colonoscopist Responsibility
Levin underscored that responsibility for addressing this challenge lies with both physicians ordering the tests and colonoscopists receiving referrals. He emphasized the importance of prioritizing these patients in scheduling queues.
“There is no way to know how your patients are doing unless you have a way to track them to colonoscopy completion,” Levin stated.
The current study provides critically important real-world evidence, utilizing recent national claims data from a large and diverse population, filling a critical gap in the literature. Ultimately, ensuring high follow-up rates is paramount to realizing the full potential of blood-based colorectal cancer screening and improving patient outcomes.
Zaki had no disclosures to report. The remaining authors’ disclosures are detailed in the published study. Levin reported receiving research support from Freenome and serving as an advisor to Geneoscopy.