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.