Journal of Community Health

, Volume 38, Issue 5, pp 829–833

Adherence to Repeat Fecal Occult Blood Testing in an Urban Community Health Center Network

  • David T. Liss
  • Anita Petit-Homme
  • Joe Feinglass
  • David R. Buchanan
  • David W. Baker
Original Paper


Annual fecal occult blood testing (FOBT) has the potential to reduce colorectal cancer mortality, but in practice it is challenging to complete FOBT every year. Repeat FOBT adherence may be especially low in community health center (CHC) settings, where many patients face barriers to annual FOBT completion. We conducted a retrospective cohort analysis to investigate adherence to annual FOBT in an urban CHC network that serves a predominantly Spanish-speaking, uninsured adult patient population. This study used data from the two-year period between January 2010 and December 2011, and included adults aged 50–74 who completed a screening FOBT with a negative result during the first 6 months of 2010. We examined whether each patient completed a second FOBT between 9 and 18 months after the initial negative FOBT, and tested whether repeat FOBT adherence was associated with patient characteristics or the number of clinic visits after the initial negative FOBT. Only 69 of 281 included patients completed repeat FOBT (24.6 % adherence), and none of 62 patients (0 %) with 0 clinic visits completed repeat FOBT. We detected no significant differences in adherence by age, sex, preferred language, insurance status, or number of chronic conditions. In multivariable regression, the adjusted relative risk of repeat FOBT was 1.66 (95 % CI 1.09–2.54; p = 0.02) among patients with 3 or more clinic visits (referent: patients with 1–2 visits). The observed low rate of adherence greatly diminishes the effectiveness of FOBT in reducing CRC mortality. Findings demonstrate the need for systems-based interventions that increase adherence without requiring face-to-face encounters.


Colorectal cancer Cancer screening Adherence Preventive care Disparities 


  1. 1.
    U.S. Preventive Services Task Force. (2008). Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 149(9), 627–637.CrossRefGoogle Scholar
  2. 2.
    Zauber, A. G., Lansdorp-Vogelaar, I., Knudsen, A. B., Wilschut, J., van Ballegooijen, M., & Kuntz, K. M. (2008). Evaluating test strategies for colorectal cancer screening: A decision analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 149(9), 659–669.PubMedCrossRefGoogle Scholar
  3. 3.
    U.S. Preventive Services Task Force. (2008). Screening for colorectal cancer: Clinical summary of U.S. preventive task force recommendation. Accessed 28 Jan 2013.
  4. 4.
    Fenton, J. J., Elmore, J. G., Buist, D. S., Reid, R. J., Tancredi, D. J., & Baldwin, L. M. (2010). Longitudinal adherence with fecal occult blood test screening in community practice. Annals of Family Medicine, 8(5), 397–401.PubMedCrossRefGoogle Scholar
  5. 5.
    Gellad, Z. F., Stechuchak, K. M., Fisher, D. A., et al. (2011). Longitudinal adherence to fecal occult blood testing impacts colorectal cancer screening quality. American Journal of Gastroenterology, 106(6), 1125–1134.PubMedCrossRefGoogle Scholar
  6. 6.
    Mandel, J. S., Bond, J. H., Church, T. R., et al. (1993). Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota colon cancer control study. New England Journal of Medicine, 328(19), 1365–1371.PubMedCrossRefGoogle Scholar
  7. 7.
    Kronborg, O., Fenger, C., Olsen, J., Jorgensen, O. D., & Sondergaard, O. (1996). Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet, 348(9040), 1467–1471.PubMedCrossRefGoogle Scholar
  8. 8.
    Crawford, N. D., Jones, C. P., & Richardson, L. C. (2010). Understanding racial and ethnic disparities in colorectal cancer screening: Behavioral risk factor surveillance system, 2002 and 2004. Ethnicity and Disease, 20(4), 359–365.PubMedGoogle Scholar
  9. 9.
    Quick, B. W., Hester, C. M., Young, K. L., & Greiner, K. A. (2013). Self-reported barriers to colorectal cancer screening in a racially diverse, low-income study population. Journal of Community Health, 38(2), 285–292.PubMedCrossRefGoogle Scholar
  10. 10.
    Percac-Lima, S., Aldrich, L. S., Gamba, G. B., Bearse, A. M., & Atlas, S. J. (2010). Barriers to follow-up of an abnormal Pap smear in Latina women referred for colposcopy. Journal of General Internal Medicine, 25(11), 1198–1204.PubMedCrossRefGoogle Scholar
  11. 11.
    Arnold, C. L., Rademaker, A., Bailey, S. C., et al. (2012). Literacy barriers to colorectal cancer screening in community clinics. Journal of Health Communication, 17(Suppl 3), 252–264.PubMedCrossRefGoogle Scholar
  12. 12.
    Coronado, G., & Thompson, B. (2000). Rural Mexican American men’s attitudes and beliefs about cancer screening. Journal of Cancer Education, 15(1), 41–45.PubMedGoogle Scholar
  13. 13.
    Soneji, S., Iyer, S. S., Armstrong, K., & Asch, D. A. (2010). Racial disparities in stage-specific colorectal cancer mortality: 1960–2005. American Journal of Public Health, 100(10), 1912–1916.PubMedCrossRefGoogle Scholar
  14. 14.
    Alexander, D. D., Waterbor, J., Hughes, T., Funkhouser, E., Grizzle, W., & Manne, U. (2007). African-American and caucasian disparities in colorectal cancer mortality and survival by data source: an epidemiologic review. Cancer Biomarkers, 3(6), 301–313.PubMedGoogle Scholar
  15. 15.
    Wang, A., Clouston, S. A., Rubin, M. S., Colen, C. G., & Link, B. G. (2012). Fundamental causes of colorectal cancer mortality: The implications of informational diffusion. Milbank Quarterly, 90(3), 592–618.PubMedCrossRefGoogle Scholar
  16. 16.
    Byers, T. (2010). Two decades of declining cancer mortality: Progress with disparity. Annual Review of Public Health, 31, 121–132.PubMedCrossRefGoogle Scholar
  17. 17.
    The Dartmouth Atlas of Health Care. (2008). List of ICD-9-CM codes by chronic disease category. Nine chronic conditions used in The Dartmouth Atlas of Health Care 2008. Accessed 28 Jan 2013.
  18. 18.
    Zou, G. (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159(7), 702–706.PubMedCrossRefGoogle Scholar
  19. 19.
    Doubeni, C. A., Laiyemo, A. O., Young, A. C., et al. (2010). Primary care, economic barriers to health care, and use of colorectal cancer screening tests among medicare enrollees over time. Annals of Family Medicine, 8(4), 299–307.PubMedCrossRefGoogle Scholar
  20. 20.
    Seeff, L. C., Nadel, M. R., Klabunde, C. N., et al. (2004). Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer, 100(10), 2093–2103.PubMedCrossRefGoogle Scholar
  21. 21.
    Ioannou, G. N., Chapko, M. K., & Dominitz, J. A. (2003). Predictors of colorectal cancer screening participation in the United States. American Journal of Gastroenterology, 98(9), 2082–2091.PubMedCrossRefGoogle Scholar
  22. 22.
    Committee on Quality of HealthCare in America. (2001). Crossing the quality chasm: A new health system for the twenty-first century. Washington, DC: Institute of Medicine.Google Scholar
  23. 23.
    Mosen, D. M., Feldstein, A. C., Perrin, N., et al. (2010). Automated telephone calls improved completion of fecal occult blood testing. Medical Care, 48(7), 604–610.PubMedCrossRefGoogle Scholar
  24. 24.
    Myers, R. E., Sifri, R., Hyslop, T., et al. (2007). A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening. Cancer, 110(9), 2083–2091.PubMedCrossRefGoogle Scholar
  25. 25.
    Liles, E. G., Perrin, N., Rosales, A. G., et al. (2012). Change to FIT increased CRC screening rates: evaluation of a U.S. screening outreach program. American Journal of Managed Care, 18(10), 588–595.PubMedGoogle Scholar
  26. 26.
    Federici, A., Giorgi Rossi, P., Borgia, P., Bartolozzi, F., Farchi, S., & Gausticchi, G. (2005). The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: A cluster randomized controlled trial. Journal of Medical Screening, 12(2), 83–88.PubMedCrossRefGoogle Scholar
  27. 27.
    Hoffman, R. M., Steel, S., Yee, E. F., Massie, L., Schrader, R. M., & Murata, G. H. (2010). Colorectal cancer screening adherence is higher with fecal immunochemical tests than guaiac-based fecal occult blood tests: A randomized, controlled trial. Preventive Medicine, 50(5–6), 297–299.PubMedCrossRefGoogle Scholar
  28. 28.
    Health Resources and Resources Administration. (2012). Approved uniform data system changes for 2012: Program assistance letter 201203. Accessed 30 Jan 2013.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • David T. Liss
    • 1
    • 2
  • Anita Petit-Homme
    • 3
  • Joe Feinglass
    • 1
    • 2
    • 4
  • David R. Buchanan
    • 1
    • 5
  • David W. Baker
    • 1
    • 2
    • 4
  1. 1.Division of General Internal Medicine and GeriatricsNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Center for Advancing Equity in Clinical Preventive ServicesNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Northwestern University Feinberg School of MedicineChicagoUSA
  4. 4.Institute for Public Health and MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  5. 5.Erie Family Health CenterChicagoUSA

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