High utilization of colonoscopy and fecal occult blood testing for screening or diagnostic purposes in Germany: a longitudinal analysis

It is often reported that participation in the German colorectal cancer (CRC) screening program is low. However, it must be considered that fecal occult blood testing (FOBT) and colonoscopy are offered in parallel and both are also used for diagnostic purposes. We aimed to quantify and characterize the uptake of these colorectal examinations in Germany. Using the claims database German Pharmacoepidemiological Research Database (~20% of the German population), we included persons aged 50 in 2011 in cohort 1 (cohort 2: age 55) and assessed whether they utilized FOBT or colonoscopy for screening or diagnostic purposes until age 59 (cohort 2: age 64). We have stratified the analyses, i.e. by gender and educational level. Among 185 949 50-year olds, 80% of women and 63% of men had ≥1 colorectal examination (i.e. FOBT or colonoscopy) until age 59; 25% of women and 31% of men had ≥1 colonoscopy (among those, 76 and 62% had a screening colonoscopy). In women with lower vs higher education, 79 vs 82% had any colorectal examination; in men, these proportions were 60 vs 67%. Among 156 258 55-year olds, 78% of women and 69% of men had ≥1 colorectal examination until age 64. Our study demonstrates a high utilization of colorectal examinations in Germany. It also illustrates the value of health claims data to monitor CRC screening in Germany due to their longitudinal character and because they include information on screening, on examinations done for diagnostic reasons as well as information suitable to characterize users and nonusers.