ADHERENCE TO CONTINUOUS SCREENING FOR COLORECTAL NEOPLASIA

Continuous screening is defined as the periodic provision of an opport unity for diagnostic testing to a population of individuals who are as ymptomatic and at increased risk for disease. If screening is offered periodically irrespective of response to an earlier screening invitati on, this situation may be referred to as serial screening. When contin uous screening is made available only to individuals who had tested pr eviously, population member response is referred to as repeat screenin g. This study assessed adherence to serial- and repeat-colorectal canc er screening among older adult members of an independent practice asso ciation-type health maintenance organization (HMO) in two consecutive rounds of screening. In the first screening round, fecal occult blood tests (FOBTs) were sent to 1,565 subjects who were randomly assigned t o receive usual care or behavioral interventions intended to encourage testing. Overall, 647 (41%) subjects completed and returned their tes ts. In the second screening round, FOBTs were mailed again to all subj ects; however, the interventions were discontinued. Logistic regressio n analysis results shows that first-round testing was a significant in dependent predictor of serial adherence for subjects older than 65 yea rs of age (odds ratio[OR] = 10.8) and those younger than 65 years of a ge (OR = 10.9); and a significant negative association between exposur e to first-round intervention and serial adherence (OR = 0.5) was foun d among younger subjects. Among first-round adherers, age was signific antly and positively related to repeat adherence (OR = 1.6). However, exposure to first-round intervention and having an abnormal FOBT resul t were significantly and negatively associated with repeat adherence ( OR = 0.5 and OR = 0.4, respectively). The results of this study report ed here indicate that previous screening is a strong predictor of seri al adherence, and special efforts may be required to achieve high leve ls of serial and repeat adherence among younger adults. Additional res earch is needed to understand why persons with abnormal screening test results are unlikely to engage in repeat screening.