Colon Cancer Screening Needs Follow-Up

Follow-Up Testing Often Missed After Positive Stool Test

Reviewed by Louise Chang, MD on June 09, 2006
From the WebMD Archives

June 9, 2006 -- More than 40% of people with a positive result on initial stool tests fail to get the necessary follow-up colon cancerscreening needed to diagnose the disease.

A new study shows that 41% of Veteran's Administration (VA) patients who received a positive result on a fecal occult blood test (FOBT, an initial screening tool for colon cancer that detects blood in stool) did not go on to receive appropriate follow-up tests such as a colonoscopy or barium enema.

"As a nation, we are getting better in providing colorectal cancerscreening, but we need to do a much better job in following up with diagnostic tests for those patients who have abnormal screening results," says researcher David A. Etzioni, MD, of the David Geffen School of Medicine at UCLA, in a news release.

Researchers say these results may actually underestimate the overall lack of follow-up in colon cancer screening nationwide because the VA's colon cancer screening and follow-up rates are generally higher than the national average. Understanding Colon Cancer: Stage By Stage


Fecal occult blood test is one of the least invasive colon cancer screening methods and detects blood in a stool sample. But other conditions may also cause blood in the stool, such as hemorrhoids.

Therefore, the FOBT is never used to diagnose colon cancer and further testing using more invasive tests such as colonoscopy or barium enema is necessary to confirm colon cancer. A colonoscopy requires sedation and involves inserting a viewing scope through the rectum to view the inside of the colon. A barium enema is an X-ray examination of the colon and rectum using barium as a contrast material so the area shows up clearly on the X-ray picture.

Follow-Up Lacking

In the study published in May issue of Diseases of the Colon and Rectum, researchers analyzed colon cancer screening and follow-up testing information on nearly 40,000 VA patients who met the criteria for colon cancer screening.

Overall, 61% were screened for colon cancer, and of those who received a positive result on a fecal occult blood test, 59% received a follow-up colonoscopy or barium enema. Forty-one percent received no follow-up at all in the six months after the positive FOBT.


Researchers say the results highlight the need to not only look at initial cancer screening rates to judge quality of health care, but to measure follow-up monitoring and testing as well.

"Any health care system that provides cancer screening programs needs to track each step in the screening process," says Etzioni. "Many patients were not offered any kind of total colon examination after having a positive screening for colon cancer. Traditionally, quality-of-care assessments just look at initial screening rates for colon cancer, but this study reveals that efforts should focus on the entire diagnostic process to help ensure that patients don't slip through cracks in the system."

Researchers say potential solutions to improve follow-up colon cancer screening may include educating patients to ask for further screening and follow-up and putting electronic systems in place to track follow-up.

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SOURCES: Etzioni, D. Diseases of the Colon & Rectum, May 2006; vol 49: pp 1-9. News release, UCLA.

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