When colorectal cancer screening isn’t enough

Colorectal cancer screening can save lives. But the challenge isn't just getting people tested. It's making sure they complete the follow-up care that comes next. How can health systems help?

A new study from researchers at Duke University and the National Cancer Centre Singapore highlights strategies that can improve follow-up care after abnormal colorectal cancer screening results.

Published in JAMA Internal Medicine, the study evaluated interventions designed to increase completion of follow-up colonoscopy after an abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT), two commonly used colorectal cancer screening methods. An analysis of 21 studies involving more than 19,000 patients found that approaches such as patient navigation, patient reminders, and clinician reminders were associated with higher rates of follow-up colonoscopy completion.

The publication reflects a collaboration between corresponding authors Michael Pignone, MD, MPH, of Duke University School of Medicine and a member of Duke Cancer Institute, and Kennedy Ng, MBBS, MPA, of the National Cancer Centre Singapore. The research team included investigators from institutions across Duke and Singapore's health and academic ecosystem, including SingHealth, Duke-NUS Medical School, and the National University of Singapore.

“Screening only works if abnormal findings are followed by appropriate care. Our study highlights practical steps health systems can take to help ensure that patients complete recommended follow-up and receive the full benefit of colorectal cancer screening,” Pignone said. 

According to the study, follow-up colonoscopy completion increased from approximately 48% in control groups to 69% among groups receiving interventions, underscoring the potential value of patient- and system-level approaches to improving cancer screening follow-through.

While the study examined evidence from across multiple health systems, the findings resonate with ongoing efforts in Singapore and Duke Health to improve colorectal cancer screening follow-up. For Ng, the research has direct relevance to work underway in Singapore.

“Our local team is bringing endoscopists and coordinators together to see how we can improve our colonoscopy rates among patients with an abnormal FIT result to 80%," Ng said. "While our research team works across different institutions and countries, we’re confronting many of the same public health challenges – getting more patients to receive the care they need."

Getting people tested is only part of the equation. Helping them get the care that follows is just as important. These findings offer practical approaches that can help patients move from testing to treatment. As health systems continue improving screening outcomes, the interventions highlighted in this study may help more patients receive the full benefit of colorectal cancer screening.