Many People Don’t Get Colonoscopies Even After Positive Stool Test

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Jan. 27, 2023 – Nearly half of people with a positive stool test result don’t get a potentially lifesaving, follow-up colonoscopy, according to a new study.

Researchers said that clinicians “were uniformly surprised” that their patients did not seek follow-up care.

“Obviously, that's a huge problem," study-co-author Jeff Mohl, PhD, director of research and analytics for the American Medical Group Association, told HealthDay. "If you're trying to estimate how many lives are saved, you're assuming that everyone gets follow-ups if they have a positive result, and if half of them don't do that, obviously you'll only save half as many people."

Stool tests are 71% to 92% accurate depending on screening type, according to the Cleveland Clinic. Early detection is important: when colorectal cancers are found early, 90% of people live at least another 5 years. 

The study was published this month in JAMA Network Open. Researchers analyzed data for 32,769 people age 50 to 75 who received a positive stool-based screening test result between January 2017 and June 2020.

Overall, 56% of people scheduled follow-up colonoscopies within 1 year. The health care providers of the patients who didn’t get colonoscopies said perceived discomfort of the procedure may have played a role in their patients’ decisions. 

Colonoscopies screen for colorectal cancers and potentially precancerous polyps. The procedure is typically done on an outpatient basis, lasts about an hour, and requires dietary adjustments and taking a laxative beforehand.

People should begin colorectal screenings starting at age 45, according to guidelines from an independent panel. People with average risk levels can first do stool-based screening tests like those involved in the study.

Researchers found that the likelihood of scheduling a follow-up colonoscopy was impacted by a person’s race, ethnicity, insurance type, and the type of screening they used (fecal immunochemical tests or multitarget stool DNA). Socioeconomic factors and the COVID-19 pandemic were significantly associated with lower follow-up rates.

Study authors noted that few health systems tracked whether patients got a colonoscopy after a positive stool result, and recommended prioritizing the backlogs.