Fecal Immunochemical Testing for Colorectal Cancer Prevention in Two Public Hospitals.

Area of Science:

• Gastroenterology
• Oncology
• Public Health

Background:

• Fecal immunochemical test (FIT) effectively reduces colorectal cancer (CRC) mortality.
• Patient adherence to CRC screening remains a significant challenge.
• Quality improvement (QI) initiatives are essential for assessing screening adherence and outcomes.

Purpose of the Study:

• To assess screening adherence and findings in a quality improvement initiative for colorectal cancer (CRC) screening using the fecal immunochemical test (FIT).
• To identify factors influencing colonoscopy completion rates after a positive FIT result.

Main Methods:

• Retrospective examination of FIT specimens over a 30-month period.
• Analysis of electronic medical records for QI measures, including colonoscopy completion and findings for FIT-positive patients.
• Categorization of patients into asymptomatic and symptomatic groups to compare adherence and outcomes.

Main Results:

• 174 out of 2400 specimens had positive FIT results; 47.6% completed colonoscopy.
• Colonoscopy revealed CRC in 10%, adenomas in 51.3%, and advanced adenomas in 17.5%.
• Low adherence (47.6%) was primarily due to patient refusal, particularly in older individuals, leading to missed CRC diagnoses.

Conclusions:

• High prevalence of colorectal adenomas and cancers in FIT-positive patients underscores the importance of screening.
• Low adherence rates, especially among older patients, result in missed opportunities for early CRC detection and prevention.
• Enhanced patient engagement strategies are necessary to improve CRC screening adherence in public hospital settings.