Lack of follow-up after fecal occult blood testing in older adults: inappropriate screening or failure to follow up?

Arch Intern Med. 2011 Feb 14;171(3):249-56. doi: 10.1001/archinternmed.2010.372. Epub 2010 Oct 11.


Background: It is unclear whether lack of follow-up after screening fecal occult blood testing (FOBT) in older adults is due to screening patients whose comorbidity or preferences do not permit follow-up vs failure to complete follow-up in healthy patients.

Methods: A prospective cohort study of 2410 patients 70 years or older screened with FOBT was conducted at 4 Veteran Affairs (VA) medical centers from January 1 to December 31, 2001. The main outcome measure was receipt of follow-up within 1 year of FOBT based on national VA and Medicare data. For patients with positive FOBT results, age and Charlson comorbidity scores were evaluated as potential predictors of receiving a complete colon evaluation (colonoscopy or sigmoidoscopy plus barium enema), and medical records were reviewed to determine reasons for lack of follow-up.

Results: A total of 212 patients (9%) had positive FOBT results; 42% received a complete colon evaluation within 1 year. Age and comorbidity were not associated with receipt of a complete follow-up, which was similar among patients 70 to 74 years old with a Charlson score of 0 compared with patients 80 years or older with a Charlson score of 1 or higher (48% vs 41%; P=.28). The VA site, number of positive FOBT cards, and number of VA outpatient visits were predictors. Of 122 patients who did not receive a complete follow-up within 1 year, 38% had documentation that comorbidity or preferences did not permit follow-up, and over the next 5 years 76% never received a complete follow-up.

Conclusions: While follow-up after positive FOBT results was low regardless of age or comorbidity, screening patients in whom complete evaluation would not be pursued substantially contributes to lack of follow-up. Efforts to improve follow-up should address the full chain of decision making, including decisions to screen and decisions to follow up.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Barium Sulfate
  • Cohort Studies
  • Colonoscopy / statistics & numerical data
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / prevention & control*
  • Comorbidity
  • Contrast Media
  • Enema / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hospitals, Veterans / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Medicare
  • Occult Blood*
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data*
  • Sigmoidoscopy / statistics & numerical data
  • Treatment Refusal / statistics & numerical data
  • United States
  • Veterans / statistics & numerical data*


  • Contrast Media
  • Barium Sulfate