Premature Fecal Immunochemical Testing in British Columbia Canada: a Retrospective Review of Physician and Screening Participant Characteristics

Abstract

Background: Colorectal cancer (CRC) screening is an evidence-based strategy to reduce CRC-related mortality. Objective: This study identifies physician and participant characteristics, as well as previous FIT values associated with premature FIT usage. Design: This is a retrospective review of all FITs ordered from January 1, 2016, until June 30, 2017. For each ordered FIT, the participant’s chart was reviewed to identify if a previous FIT had occurred in the prior 21 months. A premature FIT was defined as an ordered test with a negative FIT in the preceding 21 months. Participants: Screening participants were average risk for CRC, aged 50–74, and had a FIT ordered by their primary care provider in British Columbia, Canada. Main Measures: The BC College of Physicians and Surgeons’ database was used to identify the location of referring physician, date of graduation from medical school, and gender. The participant’s age, gender, and value of previous FIT were recorded. Physician and participant variables and previous FIT value were examined with logistic regression to identify associations with premature FIT ordering. Key Results: In total, 385,375 FITs were ordered during this period with 116,727 representing participants returning following a previous negative FIT. In total, 35,148 (30.1%) returned early for screening. Men were more likely to return early than women (OR 1.14; 95% CI 1.11–1.17; p < 0.0001). Male physicians were more likely to order premature FITs (OR 1.15; 95% CI 1.06–1.24; p < 0.0001). A higher quantitative FIT value (ng/mL) of the previous FIT was also associated with early screening (OR 1.11; 95% CI 1.09–1.14; < 0.0001). Conclusions: This study found that approximately 30% of FIT tests, ordered for CRC screening, were ordered before they were due. This may lead to wasted resources, unnecessary participant stress, and unwarranted patient risk.