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Hashem B. El-Serag, MD, MPH; Laura Petersen, MD, MPH; Howard Hampel, MD, PhD; Peter Richardson, PhD; Gregory Cooper, MD

Arch Intern Med. 2006;166:2202-2208.

Background  Medicare data indicate an increase in colorectal cancer (CRC) screening using colonoscopy and a decline in fecal occult blood testing, flexible sigmoidoscopy, and double-contrast barium enema. Because of differences in the delivery of health care, this trend in use of colonoscopy in fee-for-service settings might not be paralleled in the Department of Veterans Affairs (VA).

Methods  National inpatient and outpatient VA databases were searched for codes indicative of colonoscopy, flexible sigmoidoscopy, fecal occult blood testing, and double-contrast barium enema during fiscal years 1998 to 2003 among VA users aged 49 to 75 years.

Results  The frequency of tests for CRC screening increased from 432 778 in 1998 to 1 179 764 in 2003. Of those who were screened, only the proportion of subjects screened with fecal occult blood testing increased from 81.7% to 90.4%, while screening colonoscopy declined from 5.7% to 4.7%; flexible sigmoidoscopy declined from 8.3% to 3.6%; and double-contrast barium enema declined from 4.1% to 1.3%. The total use of screening colonoscopy procedures increased from 24 955 in 1998 to 55 199 in 2003, but the proportion of colonoscopy procedures performed for CRC screening purposes increased only slightly from 34.3% to 38.4%. In regression models adjusting for age, race, and sex, there was no consistent secular trend in the likelihood of undergoing screening colonoscopy for patients cared for in the VA health care system.

Conclusions  Colorectal cancer screening has dramatically increased in the VA, but unlike in other practice settings, fecal occult blood testing is the dominant mode of screening. Although screening colonoscopy more than doubled in frequency, it constitutes a small proportion of the total CRC screening procedures used in the VA health care setting.

Author Affiliations: Houston Center for Quality of Care and Utilization Studies and Gastroenterology at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Tex (Drs El-Serag, Petersen, Hampel, and Richardson); and Case Western Reserve University, Cleveland, Ohio (Dr Cooper).

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