Modifiable Failures In The Colorectal Cancer Screening .

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Risk of Dying from Colorectal Cancer (CRC)62% 2-fold higher risk of CRC death inthose who were not up to dateLower riskof dying from CRC inpatients who wereup to date onscreening76%of people dying ofCRC were not up todate on screening*Reference group is those up to date on screening –numbers shown are the point estimates.Distribution of screening failures inCRC deaths and CRC-free people

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Association between screening patternsand CRC death, KPNC/KPSC 2006-2012Models and screening histories analyzed Cases, n Controls, nOR, 95% CIModel on up-to-date status:Not up-to-dateUp-to-dateModel 3:Up to date on screeningFailure to ever screenFailure to screen at appropriateintervalsFailure to receive surveillanceFailure to follow-up for abnormal test1,3284221930 1.0 (Ref)1556 0.38 (0.33-0.44)4225911556 1.0 (Ref)884 2.46 (2.08-2.91)574929 2.36 (2.00-2.78)2241 2.15 (1.24-3.73)14176 7.26 (5.26-10.03)Estimates from separate conditional logistic models of screening histories on risk of CRC death adjusted for race-ethnicity,SES, Charlson score, and primary care visits. Not up-to-date included failures to screen and failure to follow-up on abnormalresultDoubeni et al. Gastroenterology. 2019

Crude associations between failures of follow-up and CRCdeath in those at-risk for failure of follow-up or surveillanceFailure typeSurveillance FailureYesNoPositive FOBTYesNoAny abnormal or positiveYesNo*Any abnormal or positiveYesNo**Failure of follow-up or surveillance†YesNoCases ControlsOR and CI22134177Ref3.17 (1.41–7.14)103294277Ref6.51 (3.50–12.10)14141*76156*Ref7.06 (4.30–11.58)1413676121Ref6.70 (4.90–9.19)16349117198Ref5.63 (3.67–8.63)The crude or unadjusted odds ratios and 95% confidence intervals from the respective 2 X 2 contingency table cells using the STATA tabodds. *Thisanalysis included patients who were up-to-date and were at-risk for failure of both diagnostic testing and surveillance (n 40; 5 case patients and 35 controlpatients). **This analysis excluded patients who were at-risk for failure both of diagnostic testing and surveillance, were up-to-date at the diagnosis date.†Analysis included all patients flagged for follow-up or surveillance testing and included those who were also at-risk for diagnostic testing.Doubeni

“For my part I know nothing with any certainty, but the sight of the stars makes me dream” - Vincent Van Gogh For more information: Doubeni et al. Modifiable failures in the colorectal cancer screening process and their association with risk of death. G

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