Cancer Causes & Control

, Volume 27, Issue 7, pp 881–887 | Cite as

Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients

  • David T. LissEmail author
  • Tiffany Brown
  • Ji Young Lee
  • Marjorie Altergott
  • David R. Buchanan
  • Anne Newland
  • Jessica N. Park
  • Sarah S. Rittner
  • David W. Baker
Original paper



Fecal occult blood testing (FOBT) is a pragmatic screening option for many community health centers (CHCs), but FOBT screening programs will not reduce mortality if patients with positive results do not undergo diagnostic colonoscopy (DC). This study was conducted to investigate DC completion among CHC patients.


This retrospective cohort study used data from three CHCs in the Midwest and Southwest. The primary study outcome was DC completion within 6 months of positive FOBT among adults age 50–75. Patient data was collected using automated electronic queries. Manual chart reviews were conducted if queries produced no evidence of DC. Poisson regression models described adjusted relative risks (RRs) of DC completion.


The study included 308 patients; 63.3 % were female, 48.7 % were Spanish speakers and 35.7 % were uninsured. Based on combined query and chart review findings, 51.5 % completed DC. Spanish speakers were more likely than English speakers to complete DC [RR 1.19; 95 % confidence interval (CI) 1.04–1.36; P = 0.009], and DC completion was lower among patients with 0 visits than those with 1–2 visits (RR 2.81; 95% CI 1.83–4.33; P < 0.001) or ≥3 visits (RR 3.06; 95% CI 1.57–5.95; P = 0.001).


DC completion was low overall, which raises concerns about whether FOBT can reduce CRC mortality in practice. Further research is needed to understand whether CHC navigator programs can achieve very high DC rates. If organizations use FOBT as their primary CRC screening approach and a substantial number of patients receive positive results, both screening rates and DC rates should be measured.


Colorectal cancer Cancer screening Diagnosis Disparities Preventive care 



We thank the following individuals for collecting manual chart review data at each participating community health center: Michelle Johnson, MPH at PCC Community Wellness; Regina Knight at North Country HealthCare, and; Devin Gosberry and Elizabeth Schrier at Erie Family Health Center.


Funding support was provided by the Agency for Healthcare Research and Quality (No. P01 HS021141).

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10552_2016_763_MOESM1_ESM.pdf (98 kb)
Supplementary material 1 (PDF 99 kb)
10552_2016_763_MOESM2_ESM.xlsx (18 kb)
Supplementary material 2 (XLSX 19 kb)
10552_2016_763_MOESM3_ESM.xlsx (15 kb)
Supplementary material 3 (XLSX 15 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • David T. Liss
    • 1
    Email author
  • Tiffany Brown
    • 1
  • Ji Young Lee
    • 1
  • Marjorie Altergott
    • 2
  • David R. Buchanan
    • 3
  • Anne Newland
    • 4
  • Jessica N. Park
    • 5
  • Sarah S. Rittner
    • 5
  • David W. Baker
    • 1
    • 6
  1. 1.Division of General Internal Medicine and Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.PCC Community Wellness CenterOak ParkUSA
  3. 3.Erie Family Health CenterChicagoUSA
  4. 4.North Country HealthCareFlagstaffUSA
  5. 5.Alliance of Chicago Community Health ServicesChicagoUSA
  6. 6.The Joint CommissionOakbrook TerraceUSA

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