Screening program for colorectal cancer: participation and follow up

The benefit of screening for colorectal cancer with the fecal occult blood test (FOBT) remains controversial. In 1985, an annual FOBT screening program for colorectal cancer was begun at Harvard Community Health Plan (HCHP). We subsequently reviewed 409 randomly selected medical records of members over age 50 to determine whether screening had been performed, how members with positive test results were evaluated by their physicians, and what gastrointestinal lesions were found as a result of positive screening tests. One hundred and ninety seven of 409 members (48%) were screened at least once during the two-year study period. One hundred and eight of 180 members (60%) who had one periodic health review (PHR) and 72 of 88 members (82%) who had two or more PHRs during the study period were screened at least once. Sixteen of 197 members who were screened at least once (8%) had positive tests. Eleven of the 16 members with positive tests were adequately evaluated by their physicians. Four had colorectal polyps and five had some other benign gastrointestinal lesion. The conclusion drawn is that FOBT screening for colorectal cancer is practical in the HMO setting. Members who have periodic health reviews are more likely to participate in screening. Physicians and members must be better educated to ensure adequate evaluation of positive tests.