Clinical factors associated with adherence to the follow-up examination after positive fecal occult blood test in national colorectal cancer screening

Abstract

Background: The compliance with the follow-up examination after a positive fecal occult blood test (FOBT) is lower than expected. We aimed to evaluate the adherence rate to the follow-up examination in patients with a positive FOBT and to identify the clinical factors associated with this adherence. Methods: The study population comprised adults aged ≥50 years who participated in the National Cancer Screening Program for colorectal cancer (CRC) in 2013. Compliance was defined as undergoing follow-up examination within 1 year of a positive FOBT. Results: From 214,131 individuals with a positive FOBT, 120,911 (56.5%) were in the compliance group and 93,220 (43.5%) were in the non-compliance group. On multivariate analysis, good compliance was associated with men (odds ratio (OR) = 1.12, 95% confidence interval (CI) (1.09–1.15)), younger ages (70–79 years, OR = 2.19 (2.09–2.31); 60–69 years, OR = 3.29 (3.13–3.46); 50–59 years, OR = 3.57 (3.39–3.75) vs. >80 years), previous experience of CRC screening (a negative FOBT, OR = 1.18 (1.15–1.21); a positive FOBT, OR = 2.42 (2.31–2.54)), absent previous experience of colonoscopy or barium enema (OR = 2.06 (1.99–2.13)), higher economic income (quartile, 75%, OR = 1.14 (1.11–1.17); 100%, OR = 1.22 (1.19–1.25)), current smokers (OR = 1.12 (1.09–1.15)), alcohol intake (OR = 1.03 (1.01–1.05)), active physical activity (≥3 times/week, OR = 1.13 (1.11–1.15)), depression (OR = 1.11 (1.08–1.14)), and present comorbidities (Charlson Comorbidity Index, ≥1). Conclusion: This study identified clinical factors, namely, male, younger ages, prior experience of fecal test, absent history of colonoscopy or double-contrast barium enema (DCBE) within 5 years, and high socioeconomic status to be associated with good adherence to the follow-up examination after a positive FOBT.