JMIR Publications

ABSTRACT

Background:

Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through removal of pre-cancerous polyps. For average risk patients, there are three commonly used screening tests used in the United States—two types of stool tests collected at home (FIT/FOBT and FIT-DNA) and colonoscopy completed at procedural centers.

Objective:

This study’s purpose is to examine variation by month for the three types of CRC testing to evaluate consistent patient care by clinical staff.

Methods:

Data from 31 federally qualified health center (FQHC) clinics in Missouri from 2011-2023 were analyzed. A sample of 37,994 unique eligible patients were identified. Simple statistics characterize the sample, while bivariate analyses assess differences in screening types by month.

Results:

In the post COVID-19 era, from 2021 to 2023, colonoscopy testing remained stable with about one third of patients (38%) completing this test. Whereas FIT-DNA increased (16% to 26%) and FIT/FOBT decreased (46% to 35%). Completion of CRC screening yielded statistically significant differences for patients completing the different types of CRC screening by month. For patients who received a colonoscopy (n=7,850), October – January were the highest months for screening, while February-April was the lowest. For FIT/FOBT (n=6,818), March-August was higher whereas December-February were the lowest screening months. For FIT-DNA (n=2,663), March was the most popular month followed by April, May and November, with January the lowest month of testing.

Conclusions:

Home-based tests are more popular than the gold standard, colonoscopy. However, variation of screening over the course of a year suggests under-utilized CRC screening efforts and therefore less than ideal patient care. Months with lower rates of screening for each type of CRC test represent opportunities for improving CRC screening.