National CRC Screening Summit

Levin
Pdf Summary
This document addresses the critical role of endoscopists in improving follow-up after positive stool-based colorectal cancer (CRC) screening tests (SBT), such as FIT or mt-sDNA. Timely follow-up colonoscopy after abnormal stool tests is essential due to its association with reduced CRC incidence and mortality. However, follow-up rates are often below 50%, with delayed follow-up linked to increased advanced-stage CRC risk.<br /><br />Multiple studies and large datasets (e.g., AMGA Collaborative, VA data) demonstrate wide variation in colonoscopy follow-up within 90 days of abnormal stool tests, influenced by factors like insurance type, comorbidities, geographic disparities, and system-level barriers. Key causes of inadequate follow-up include patient reluctance, access challenges (transportation, time off work), fragmented electronic records, unclear referral pathways, poor insurance coverage, and restrictive GI practice policies (e.g., requirements for pre-colonoscopy visits).<br /><br />To address these challenges, the proposed white paper advocates evidence-based interventions involving endoscopists, such as patient navigation, robust tracking and metrics, clear policies prioritizing stool test follow-up, and minimizing referral barriers by leveraging electronic health records and eliminating unnecessary pre-referral primary care visits. The paper emphasizes the importance of direct access colonoscopy (scheduling colonoscopy without a prior GI visit) which can reduce delays, improve adherence, and enhance CRC screening efficiency, although it requires thoughtful implementation with safeguards for complex patients.<br /><br />The manuscript outlines best practices adaptable to various health care settings—including VA, multispecialty groups, academic centers, and safety-net clinics—and highlights the need for shared responsibility among primary care, endoscopy, and quality teams. Ultimately, improving stool-based test follow-up depends on coordinated health system efforts, with endoscopists playing a pivotal leadership role in removing barriers to timely colonoscopy, thereby enhancing cancer detection and reducing morbidity and mortality. A draft white paper is expected for ASGE Board review by late 2024.
Keywords
endoscopists
colorectal cancer screening
stool-based tests
follow-up colonoscopy
FIT
mt-sDNA
patient navigation
direct access colonoscopy
health system barriers
timely follow-up