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Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death.

Chyke A Doubeni1, Stacey A Fedewa2, Theodore R Levin3

  • 1Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Gastroenterology
|October 1, 2018
PubMed
Summary
This summary is machine-generated.

Colorectal cancer (CRC) deaths are often preventable. Most CRC deaths occurred in patients not up to date with screening, highlighting the importance of regular screening and timely follow-up for abnormal results to reduce CRC mortality.

Keywords:
AdenomaCancer PreventionColon CancerEarly Detection

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Area of Science:

  • Oncology
  • Preventive Medicine
  • Public Health

Background:

  • Colorectal cancer (CRC) mortality is linked to missed screening, inadequate follow-up of abnormal results, or screening test failures.
  • Limited data exist on the specific contributions of these factors to CRC deaths and associated risk factors.

Purpose of the Study:

  • To investigate the contribution of screening adherence and follow-up of abnormal results to colorectal cancer deaths.
  • To identify factors associated with CRC-associated mortality in a large healthcare system.

Main Methods:

  • A retrospective cohort study analyzed patients aged 55-90 who died of CRC between 2006-2012.
  • Data on CRC screening and follow-up were collected from electronic records and chart audits for 10 years prior to diagnosis.
  • A matched cohort of cancer-free patients was used for comparison.

Main Results:

  • Most CRC deaths (75.9%) occurred in patients not up to date with screening.
  • Failure to screen or screen at appropriate intervals was associated with a 2.40 odds ratio for CRC death.
  • Failure to follow up on abnormal results significantly increased CRC death risk (OR, 7.26).

Conclusions:

  • Maintaining up-to-date colorectal cancer screening significantly reduces the risk of CRC death.
  • Rectifiable screening process failures, particularly lack of follow-up on abnormal findings, are major contributors to CRC mortality even in systems with high screening rates.