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Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death.
- Source :
-
Gastroenterology [Gastroenterology] 2019 Jan; Vol. 156 (1), pp. 63-74.e6. Date of Electronic Publication: 2018 Sep 27. - Publication Year :
- 2019
-
Abstract
- 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 fails. We have few data on the contribution of each to CRC-associated deaths or factors associated with these events.<br />Methods: We performed a retrospective cohort study of patients in the Kaiser Permanente Northern and Southern California systems (55-90 years old) who died of CRC from 2006 through 2012 and had ≥5 years of enrollment before diagnosis. We compared data from patients with those from 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 before diagnosis were obtained from electronic databases and chart audits.<br />Results: Of 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. Of 3486 cancer-free patients, 44.6% were up to date in their screening. Patients who were up to date in their screening had a lower risk of CRC death (odds ratio, 0.38; 95% confidence interval, 0.33-0.44). Failure to screen, or failure to screen at appropriate intervals, occurred in a 67.8% of patients who died of CRC vs 53.2% of cancer-free patients; failure to follow-up on abnormal results occurred in 8.1% of patients who died of 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 (odds ratio, 2.40; 95% confidence interval, 2.07-2.77) and failure to follow-up on abnormal results (odds ratio, 7.26; 95% confidence interval, 5.26-10.03).<br />Conclusions: Being up to date on screening substantially decreases the risk of CRC death. In 2 health care systems with high rates of screening, most people who died of CRC had failures in the screening process that could be rectified, such as failure to follow-up on abnormal findings; these significantly increased the risk for CRC death.<br /> (Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adenocarcinoma prevention & control
Aged
Aged, 80 and over
California epidemiology
Cause of Death
Colorectal Neoplasms prevention & control
Early Detection of Cancer adverse effects
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care
Predictive Value of Tests
Protective Factors
Reproducibility of Results
Retrospective Studies
Risk Factors
Time Factors
Adenocarcinoma diagnosis
Adenocarcinoma mortality
Colorectal Neoplasms diagnosis
Colorectal Neoplasms mortality
Early Detection of Cancer mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0012
- Volume :
- 156
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 30268788
- Full Text :
- https://doi.org/10.1053/j.gastro.2018.09.040