Time to fecal immunochemical test completion for colorectal cancer screening

Am J Manag Care. 2019 Apr;25(4):174-180.


Objectives: Fecal immunochemical tests (FITs) can efficiently screen for colorectal cancer (CRC), but little is known on the timing to their completion. We investigate the time to return of a FIT following an order and describe patient characteristics associated with FIT return.

Study design: Retrospective cohort study.

Methods: We identified 63,478 members of Kaiser Permanente Washington, aged 50 to 74 years, who received a FIT order from 2011 through 2012. Patient characteristics were ascertained through administrative and electronic health record data sources. We compared time from FIT order to return by patient characteristics using Kaplan-Meier and Cox regression methods.

Results: About half (53.7%) of members completed a FIT. Median time from order to return was 13 days (mean, 44.5 days; interquartile range, 6-42 days). There was higher completion of FITs among Asian patients (hazard ratio [HR], 1.43; 95% CI, 1.38-1.48), black patients (HR, 1.13; 95% CI, 1.08-1.19), and Hispanic patients (HR, 1.10; 95% CI, 1.04-1.16) compared with white patients; among patients with recent CRC testing (vs no testing in past 2 years; HR, 1.90; 95% CI, 1.86-1.95); and among patients with Medicare insurance (vs commercial; HR, 1.30; 95% CI, 1.24-1.37). Factors associated with decreased FIT completion included younger age (50-54 years vs 70-74 years; HR, 0.87; 95% CI, 0.82-0.92), obesity (vs normal body mass index; HR, 0.88; 95% CI, 0.86-0.91), and higher Charlson Comorbidity Index score (≥3 vs 0; HR, 0.82; 95% CI, 0.79-0.87).

Conclusions: Time to return of FIT varies by patient characteristics. We observed greater FIT completion among people of color, suggesting that racial disparities in CRC may not be due to patient completion of the test after an order is received.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / prevention & control
  • Comorbidity
  • Early Detection of Cancer / methods*
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • Humans
  • Immunohistochemistry
  • Insurance, Health / statistics & numerical data
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Occult Blood*
  • Racial Groups / statistics & numerical data
  • Regression Analysis
  • Retrospective Studies
  • Socioeconomic Factors
  • Time Factors
  • United States