Data indicate that potentially avoidable failures in the screening process for colorectal cancer (CRC) lead to preventable death, particularly in disadvantaged populations, and addressing such failures can improve the benefits of screening. “Unfortunately, there is sparse research in this area, and many studies have focused on simply assessing whether or not a person received screening, as opposed to whether all screening steps were completed, including timely diagnostic testing for abnormal results,” says Chyke A. Doubeni, MD, MPH.

For a study published in Gastroenterology, Dr. Doubeni and colleagues sought to understand the types of modifiable failures that occur in CRC screening process and how they affect risk for CRC-related death.

Among 1,750 CRC-related deaths, about 76% of patients dying from colorectal cancer had identifiable failures of the screening process prior to the date of diagnosis and about one-quarter of patients died despite being up to date, explains Dr. Doubeni. Among 3,486 cancer-free patients, 44.6% were up to date on their screening. Patients who were up to date on their screening had a lower risk of CRC-related death (odds ratio, 0.38).

“Failure to receive follow-up after an abnormal or incomplete test increased the risk of dying from CRC by about seven-fold,” adds Dr. Doubeni, “emphasizing the importance of promptly closing the loop for patients with either incomplete tests or abnormal results. Systems should be in place to ensure that people who are eligible for screening are up to date and, in particular, have processes to improve follow-up for those with abnormal results or an incomplete test. This often requires tracking systems, automated referral to gastroenterologists, and support in navigating the health system to receive testing at appropriate intervals and follow-up when needed.”


Modifiable Failures in the CRC Screening Process and Risk of Death