Introduction In the UK, population based colorectal cancer (CRC) screening is conducted based on biennial faecal occult blood testing (FOBT), with follow-up colonoscopy for positive results. However, a proportion of FOBT-positive subjects do not undergo colonoscopy, due to individual choice, comorbidity or current/recent colonic investigations for symptoms. The aim of this study was to evaluate this group of FOBT screen-positive subjects who do not undergo a screening colonoscopy.
Method Retrospective audit of prospectively collected data within the North East Scotland bowel screening database, between 1/06/2007 to 31/05/2013. Data was collected for reasons why colonoscopy was not performed, as well as the performance and results of further alternative imaging.
Results During the 6 year period of the audit, 4975 screening colonoscopy referrals were received for 4704 individuals (253 subjects had presented through 2 rounds and 18 through 3 rounds of the screening programme). Overall, 1081 (21.73%) referrals did not have a colonoscopy performed; 492 (45.5%) declined, a clinical decision was made in 525 (48.6%), 46 (4.3%) were under surveillance, 14 (1.3%) did not attend the appointment, 2 (0.01%) individuals died and no reason was identified in 2 cases.
Of the 492 subjects that declined colonoscopy, 36 (7.3%) had the procedure performed in the private sector, other reasons were recorded in 34 (6.9%) cases and no reason was recorded for the remaining subjects.
Of the 525 cases in whom a clinical decision was made not to perform colonoscopy, the reasons were recorded as significant co-morbidity in 159 (30.3%) with 25 (4.8%) cases of cancer, 151 (28.8%) subjects had colonic imaging within the previous 12 months, 26 (5%) had active IBD, 118 (22.5%) were in the symptomatic service with a colonoscopy appointment already arranged, 12 (2.3%) individuals had previous failed colonoscopies on >1 occasion, and other/no reason was recorded in 59 (11.2%) subjects.
Radiological colonic imaging (as an alternative to colonoscopy) was performed in 109 subjects: 38 CT colonography, 32 barium enema and 41 minimal-preparation CT scan abdomen/pelvis. Twelve cases of colorectal cancer were diagnosed in this group.
Conclusion The major reasons for screening colonoscopy not being performed are individuals declining or a clinical decision, with co-morbidity a major factor. Radiological imaging in selected cases has a significant yield for colorectal cancer.
Disclosure of interest None Declared.
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