title: Inappropriate colorectal cancer screening: findings and implications.
abstract: OBJECTIVE
  Inclusion of colorectal cancer screening as a performance measure in the Veterans Health Administration (VHA) health system appears to have improved screening rates but may have also increased inappropriate screening. Our aim was to ascertain whether the fecal occult blood test (FOBT) was being ordered appropriately.
  
  
  METHODS
  We examined records of 500 consecutive primary care patients at a single VHA facility for whom FOBT had been ordered to determine whether the FOBT was appropriate and, if not, the reason why.
  
  
  RESULTS
  We found that 18% of the sample had severe comorbid illness, 13% had signs or symptoms of gastrointestinal blood loss, 7% had a history of colorectal neoplasia or inflammatory bowel disease (high risk), 5% had undergone colonoscopy within prior 5 yr, and 3% were younger than 50 yr of age. Overall, 35% of the patients had at least one reason that the FOBT was inappropriate and at least 19% of the patients should not have undergone any colorectal cancer test for screening or diagnosis.
  
  
  CONCLUSIONS
  The FOBT order was inappropriate in a third of the sample, most commonly because of a documented life-limiting comorbidity. In addition, data suggested that FOBT was being used for diagnosis instead of screening. Screening patients unlikely to live long enough to develop and die from colorectal cancer provides no benefit and places these individuals at unjustifiable risk. Additionally, inappropriate screening utilizes resources that could be used to improve screening and follow-up for eligible individuals.
authors.affiliation: Institute for Clinical and Epidemiological Research, Durham Veterans Affairs Medical Center, North Carolina, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Latisha
authors.initials: L
authors.lastname: Judd
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Sanford
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D003113:Colonoscopy; D000075202:Contraindications; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis; D006300:Health Services Misuse; D006787:Hospitals, Veterans; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D012307:Risk Factors