Assessing screening quality in the CDC's Colorectal Cancer Screening Demonstration Program

Authors

  • Marion R. Nadel PhD, MPH,

    Corresponding author
    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
    • Corresponding author: Marion R. Nadel, PhD, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-76, Atlanta, GA 30341; Fax: (770) 488-4286; mrn1@cdc.gov

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  • Janet Royalty MS,

    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Jean A. Shapiro PhD,

    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Djenaba Joseph MD, MPH,

    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Laura C. Seeff MD,

    1. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Dorothy S. Lane MD, MPH,

    1. Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
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  • Diane M. Dwyer MD

    1. Center for Cancer Prevention and Control, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
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  • The articles in this supplement were commissioned based on participation in evaluating the Centers for Disease Control and Prevention-funded Colorectal Cancer Screening Demonstration Program.

  • The opinions or views expressed in this supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the journal editors, the American Cancer Society, John Wiley & Sons Inc, or the Centers for Disease Control and Prevention.

  • We gratefully acknowledge William Helsel, William Kammerer, William Howe, and Tanner Rockwell of Information Management Services Inc for providing analytical and data management support.

Abstract

BACKGROUND

Gaps in screening quality in community practice have been well documented. The authors examined recommended indicators of screening quality in the Centers for Disease Control and Prevention's Colorectal Cancer Screening Demonstration Program (CRCSDP), which provided colorectal cancer screening and diagnostic services between 2005 and 2009 for asymptomatic, low-income, underinsured, or uninsured individuals at 5 sites around the United States.

METHODS

For each client screened in the CRCSDP, a standardized set of colorectal cancer clinical data elements was collected. Data regarding client age, screening history, risk level, screening test indication, results, and recommendation for the next test were analyzed. For colonoscopies, data were analyzed regarding whether the cecum was reached, bowel preparation was adequate, and identified lesions were completely removed.

RESULTS

Overall, 53% of the fecal occult blood tests (FOBTs) (2295 tests) distributed were completed and returned. At the 2 sites with adequate numbers of FOBTs, 77% and 97%, respectively, of clients with positive results received follow-up colonoscopies. Site-specific cecal intubation rates ranged from 90% to 98%. Adenoma detection rates were 32% for men and 21% for women. For approximately one-third of colonoscopies, the recommended interval to the next test was shorter than recommended by national guidelines. At some sites, endoscopists failed to report on the adequacy of bowel preparation and completeness of polyp removal.

CONCLUSIONS

Cecal intubation rates and adenoma detection rates met recommended levels. The authors identified the need for improvements in the follow-up of positive FOBTs, documentation of important elements in colonoscopy reports, and recommendations for rescreening or surveillance intervals after colonoscopy. Monitoring quality indicators is important to improve screening quality. Cancer 2013;119(15 suppl):2834–41. © 2013 American Cancer Society.

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