Digestive Diseases and Sciences

, Volume 57, Issue 2, pp 288–293 | Cite as

Colorectal Cancer Testing in the National Veterans Health Administration

  • Millie D. Long
  • Trang Lance
  • Douglas Robertson
  • Leila Kahwati
  • Linda Kinsinger
  • Deborah A. Fisher
Original Article



Colorectal cancer (CRC) screening is a priority for the Veteran’s Health Administration (VHA). Optimizing fecal occult blood testing (FOBT) is integral to CRC screening in health care systems.


The purpose of this study was to characterize the utilization of CRC testing in a large integrated health care system (VHA), determine current rates of CRC testing by FOBT and examine factors associated with lack of FOBT card return.


The VHA Office of Quality and Performance (OQP) collected data from a national sample of Veterans from October 2008 to September 2009. Rates and modality of CRC testing for eligible Veterans were calculated. Among those offered FOBT, bivariate analyses were performed to describe population characteristics by FOBT return. Logistic regression was used to determine factors independently associated with lack of FOBT return.


A total of 36,336 Veterans were included. On weighted analysis, 80.4% of Veterans received a form of CRC screening. The majority underwent colonoscopy in the prior 10 years (71.6%), followed by FOBT in the prior year (24.0%). A total of 31.0% did not return FOBT cards that were provided. Factors associated with a lack of FOBT return included: younger age, female gender, non-Caucasian race, living in the Northeast, current smoking and lack of influenza vaccination.


Overall rates of CRC screening in VHA are high. Systems-based practices within VHA likely play a role in successful CRC screening. CRC screening is most often via colonoscopy, followed by FOBT. Characteristics associated with non-adherence with FOBT may inform future quality improvement initiatives in health care systems.


Colorectal cancer Screening FOBT Colonoscopy Veterans Affairs 


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Millie D. Long
    • 1
    • 2
  • Trang Lance
    • 2
  • Douglas Robertson
    • 3
  • Leila Kahwati
    • 2
  • Linda Kinsinger
    • 2
  • Deborah A. Fisher
    • 4
    • 5
  1. 1.Division of Gastroenterology and HepatologyUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Veterans Health Administration, Office of Patient Care ServicesNational Center for Health Promotion and Disease PreventionDurhamUSA
  3. 3.White Plains Veterans Affairs Medical CenterWhite PlainsUSA
  4. 4.Health Services Research and Development Center of ExcellenceDurham Veterans Affairs Medical CenterDurhamUSA
  5. 5.Division of Gastroenterology and HepatologyDuke UniversityDurhamUSA

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