Rolling-out Screening Volume Affecting Compliance Rate and Waiting Time of FIT-based Colonoscopy

The population-based colorectal cancer screening program with fecal immunochemical test (FIT) from the inaugural period to the rolling-out period may create a higher demand for colonoscopies, but such a change has not been quantified. We intended to assess the change in the compliance rate and the waiting time (WT) for a colonoscopy and the associated geographic and institutional variations across the 2 periods.

Data from the Taiwanese nationwide colorectal cancer screening program were analyzed. The data included a total of 46,235 FIT-positive cases of 1,258,560 tests in the inaugural period (2004 to 2009) and 270,700 FIT-positive cases of 3,723,789 tests in the rolling-out period (2010 to 2013). The compliance rate and WT for colonoscopy after positive FIT was ascertained and compared between the 2 periods.

The rolling-out period resulted in a decline of 16.0% for compliance rate and yielded an additional 1,778,499 waiting days with variation across geography and institution. After adjusting for relevant factors, a decrease in compliance rate by 8.5% and an increase of 714,648 waiting days were still noted. In the rolling-out period, a remarkable decline in compliance rate by 9.8% was found in middle Taiwan, and the longest WT (1,260,109 d) was observed in southern Taiwan. Screening at public health centers led to a 19% decrease in compliance rate and an increase of 2,546,746 waiting days.

The decrease in compliance rate and an increase in the WT with variation across geography and institution resulting from the increased volume of rolling-out FIT screening provide an insight into optimal resource allocation of clinical capacity for colonoscopy.