High Rates of CRC Screening among Veterans Receiving VA Care

BACKGROUND:
Colorectal cancer (CRC) is estimated to be the third leading cause of cancer death among men and women in the U.S. CRC screening is recommended for average-risk people at age 50 years, continuing to age 75. Screening modalities recommended by the U.S. Preventive Services Task Force include fecal occult blood testing (FOBT), flexible sigmoidoscopy, or colonoscopy at appropriate intervals. As of 2009, VA’s performance measure for CRC screening was fulfilled if a Veteran, aged 51-75 years, had undergone at least one of the following tests: FOBT within the past year, flexible sigmoidoscopy within the past 5 years, colonoscopy within the past 10 years, or double contrast barium enema within the past 5 years. Because endoscopic screening is limited in some VA healthcare sites, optimization of FOBT is paramount to ensuring access to CRC screening for all Veterans. This study examined CRC testing rates in a national sample of Veterans to determine the modalities of CRC testing used and factors associated with the lack of FOBT card return. Using data collected for VA quality and performance measurement assessment from 10/08 through 9/09, investigators focused on 36,336 Veterans aged 51-75 years who had obtained VA outpatient primary care during this period. Investigators also assessed demographics and identified characteristics associated with lack of FOBT card return.

FINDINGS:

• Overall rates of CRC screening in the VA healthcare system were high (80%) among Veterans aged 51-75 years. This rate compares favorably with population estimates for the U.S., where only 60% of eligible Americans are estimated to have undergone a CRC screening test with either lower endoscopy or FOBT.
• Of Veterans who had received appropriate screening, the majority underwent colonoscopy in the prior 10 years (72%), followed by FOBT in the prior year (24%).
• A total of 31% of Veterans did not return FOBT cards that were provided. Factors associated with a lack of return included: younger age, non-Caucasian race, and current smoking.
• Secondary analyses in an augmented sample of women Veterans (n=36,404) showed that findings were similar for both genders. As with men, smoking was associated with lack of FOBT return.
• While the overall CRC testing rate among Veterans is high, there are opportunities for further improvement, such as future quality improvement initiatives to increase FOBT card return.

LIMITATIONS:

• Investigators did not have access to either the indication or the results of individual CRC screening; therefore, they could not differentiate screening from diagnostic or surveillance tests.
• CRC screening for Veterans performed outside the VA healthcare system that was not recorded in the VA electronic medical record was unavailable.

AUTHOR/FUNDING INFORMATION:
Dr. Fisher is part of HSR&D’s Center for Health Services Research in Primary Care, Durham, NC.

Long M, Lance T, Robertson D, Kahwati L, Kinsinger L, and Fisher D. Colorectal Cancer Testing in the National Veterans Health Administration. Digestive Diseases and Sciences September 16, 2011;E-pub ahead of print.