The Fecal Immunochemical Test (FIT) screening test aims to detect colorectal cancers early to improve chances of successful treatment. Reporting in The Annals of Family Medicine, Cancer Center Amsterdam researchers investigated why some people do not pursue further examination after a positive at-home test.

Every two years, people between the ages of 55 and 75 receive a Fecal Immunochemical Test (FIT) in their mailbox as part of the Dutch national screening program for colorectal cancer (CRC). However, more than 1 in 6 people who test positive do not pursue the standard follow-up colonoscopy. Why?

“Understanding the reasons why people do not follow up with their doctors after having an unfavorable cancer test result is critical for improving the success of cancer screening programs that are aimed at early detection,” says first author, Dr. Lucinda Bertels of Cancer Center Amsterdam.

The researchers conducted a survey among people who received a positive FIT to investigate. Of the 2,225 respondents who completed the survey, 730 people reported not having a follow-up colonoscopy. While 55% had medical reasons for not choosing to follow up, 45% had other reasons, which included:

  • concerns about having a colonoscopy
  • a lack of medical counseling regarding the results and follow up
  • assumptions and perceptions about their personal risk
  • having trust in the ability to self-detect CRC without follow up
  • an alternative explanation for the positive FIT
  • doubts about the effectiveness of polyp removal

The strongest positive association with follow-up was the patient's belief that their general practitioner (GP) supported the colonoscopy, as well as fear of cancer.

Based on the results, the researchers recommend exploring personalized screening counseling as a means of improving follow-up in the Dutch CRC screening program. “We also think that by involving GPs in the process, more people will have the follow-up examination done – or that they will at least be able to discuss their options and not be left with doubts themselves. Currently, this process does not involve GPs,” says Dr. Bertels.

For more information, contact Lucinda Bertels or read the publication.

Bertels, L.S.,et al. (2022) Reasons for No Colonoscopy After an Unfavorable Screening Result in Dutch Colorectal Cancer Screening: A Nationwide Questionnaire.The Annals of Family Medicine. doi.org/10.1370/afm.2871.

Research involved at Amsterdam UMC

Lucinda S. Bertels

Kristel M. van Asselt

Henk C.P.M. van Weert

Evelien Dekker

Bart J. Knottnerus

Funding

Financial resources for this study were provided by the Dutch Cancer Society (KWF).

This article was created for Cancer Center Amsterdam.

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