Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices

Prev Med. 2015 Jul:76:115-22. doi: 10.1016/j.ypmed.2015.03.028. Epub 2015 Apr 18.


Background: ColonCancerCheck (CCC), Ontario's organized colorectal cancer (CRC) screening program, uses guaiac fecal occult blood testing (gFOBT). To reduce CRC-related mortality, persons with a positive gFOBT must have colonoscopy. We identified factors associated with failure to have colonoscopy within 6months of a positive gFOBT.

Methods: Population-based, retrospective cohort analysis of CCC participants with positive gFOBT (April 2008 to December 2009) using health administrative data. Patient, physician and health care utilization factors associated with a lack of follow-up colonoscopy were identified using descriptive and multivariate analyses.

Results: There were 21,839 participants with a positive gFOBT; 14,091 (64%) had colonoscopy within 6months. The strongest factors associated with failure to follow-up were recent colonoscopy (in 2years prior vs. >10years or never, OR: 4.31, 95% C.I.: 3.82, 4.86), as well as repeat gFOBT (OR: 6.08, 95% C.I.: 5.46, 6.78) and hospital admission (OR: 4.35, 95% C.I.: 3.57, 5.26) in the follow-up period.

Conclusion: In the first 18months of the CCC Program, 1/3 of those with a positive gFOBT did not have colonoscopy within 6months. Identification of potentially modifiable factors associated with failure to follow up lay the groundwork for interventions to address this critical quality gap.

Keywords: Colonoscopy; Colorectal cancer; Fecal occult blood testing; Organized screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colonoscopy / methods*
  • Colorectal Neoplasms / diagnosis*
  • Early Detection of Cancer*
  • Female
  • Guaiac
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Occult Blood*
  • Ontario
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Retrospective Studies


  • Guaiac