Modifiable Failures in the Colorectal Cancer Screening Process and Their Association with Risk of Death.Doubeni CA, Fedewa SA, Levin TR, Jensen CD, Saia C, Zebrowski AM, Quinn VP, Rendle KA, Zauber AG, Becerra-Culqui TA, Mehta SJ, Fletcher RH, Schottinger J, Corley DA. Gastroenterology. 2018 Sep 27 [Epub ahead of print]

BACKGROUND & AIMS:Colorectal cancer (CRC) deaths occur when patients do not receive screening or have inadequate follow up of abnormal results, or when the screening test itself fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these events.

METHODS:We performed a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems (55-90 years old) who died from CRC from 2006 through 2012 and had ≥5 years of enrollment prior to diagnosis. We compared data from patients with a matched cohort of cancer-free patients in the same system. Receipt, results, indications, and follow up of CRC tests in the 10-year period prior to diagnosis were obtained from electronic databases and chart audits.RESULTS:Among 1750 CRC deaths, 75.9% (n=1328) occurred in patients who were not up to date in screening and 24.1% (n=422) occurred in patients who were up to date. Failure to screen was associated with fewer visits to primary care physicians. Among 3486 cancer-free patients, 44.6% were up to date on their screening. Patients who were up to date in their screening had reduced risk of CRC death (odds ratio [OR], 0.38; 95% CI, 0.33-0.44). Failure to screen, or failure to screen at appropriate intervals, occurred in a 67.8% of patients who died from CRC vs 53.2% of cancer-free patients; failure to follow up on abnormal results occurred in 8.1% of patients who died from CRC vs 2.2% of cancer-free patients. CRC death was associated with higher odds of failure to screen or failure to screen at appropriate intervals (OR, 2.40; 95% CI, 2.07-2.77) and failure to follow up on abnormal results (OR, 7.26; 95% CI, 5.26-10.03).CONCLUSIONS:Being up to date on screening substantially reduces risk of CRC death. In 2 healthcare systems with high rates of screening, most people who died from CRC had failures in the screening process that could be rectified, such as failure to follow up on abnormal findings; these significantly increased risk for CRC death.

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