Background. The objectives of this study were to survey compliance and iden
tify factors that influence continued participation with periodic colon can
cer screening guidelines once patients are seen for their first screening.
Methods. The study group consisted of 95 patients who had initial fecal occ
ult blood tests (FOBT) and flexible sigmoidoscopy (FS) in 1991 as part of a
gastroenterologist-directed, aggressively managed colon cancer screening r
egistry. Regular notices are sent to patients and their primary care provid
er for annual FOBT and FS at 3- to 5-year intervals.
Results. Of 70 (74%) reviewed, 2 had died and 3 were having colonoscopic su
rveillance. Thirty-two of the 65 (49%) contacted eligible study subjects we
re no longer participating. Reasons stated were as follows: unaware that sc
reening was due (14), too busy (6), unpleasant experience (3), and change t
o insurance provider that did not cover screening (9 [commercial-3, managed
care-1, Medicare-5]).
Conclusions. Despite aggressive program management, 44% of nonparticipators
reported that they were unaware that screening was due. Sixteen percent of
those who did not continue to participate had graduated to Medicare, which
did not cover screening costs. Factors that influence continued participat
ion need to be considered in the design of public education and marketing p
romotions.