Table 3.

Downstream Outcomes Classified According to Benefits and Burdens from Screening and Follow-up Practices for Patients Aged 70 years and Older with a Positive FOBT Result (N=212)

Downstream Outcomes (N)	Examples	Net Benefit or Net Burden
Follow-up Colonoscopy (N=118)
Cancer (N=6)
FOBT led to diagnosis of CRC and patient lived ≥5 yrs (N=6)	74 year-old man, status post coronary artery bypass graft, otherwise healthy, with a curative resection for rectal cancer. Two repeat colonoscopies were negative for recurrence. He remains healthy	Net Benefit
Significant Adenoma (N=34)
1) FOBT led to diagnosis of a  significant adenoma and  patient lived ≥5 years  (N=27)	79 year-old man who was relatively healthy with a large adenoma (1.5 cm) on colonoscopy. He had 4 repeat colonoscopies over 7 years which found adenomas. He remains healthy.	Net Benefit
2) FOBT led to diagnosis of a  significant adenoma but  patient died within 5 years  (n=7)	74 year-old man with severe heart disease with an implanted cardiac defibrillator, dependent in several instrumental activities of daily living and a history of multiple falls who had 2 adenomas, one large (2 cm), found on colonoscopy. He suffered a broken hip in 2003 and died in early 2004.	Net Burden
Insignificant/Normal Findings (N=78)
1) FOBT found 1-2 small  non-villous adenomas or  indeterminate pathology  and person lived ≥5 years  (n=30)	76 year-old man who was independent in instrumental activities of daily livings with 2 small adenomas (3mm, 8mm) found on colonoscopy. He had several additional procedures: Repeat FOBTs in 2002 and 2004 and repeat colonoscopy in 2005- all negative. He remains healthy.	Indeterminate
2) FOBT found no adenoma  and person lived ≥5 years  (N=35)	76 year-old man who had peripheral neuropathy with 2 hyperplastic polyps found on colonoscopy. He had repeat testing with a normal colonoscopy in 2006 and no further screening was recommended. He remains alive but quite ill.	Net Burden
3) FOBT found no significant  adenomas and person died  within 5 years (N=13)	75 year-old man with end-stage chronic obstructive pulmonary disease on home oxygen with multiple ER visits for dyspnea with 1 hyperplastic polyp found on colonoscopy. He was diagnosed with inoperable3-vessel coronary disease and severe aortic stenosis in 2004 but had a repeat colonoscopy which was negative. His angina worsened and he died in 2005.	Net Burden
No Follow-up Colonoscopy (N=94)
1) Had No Other Work-Up after +FOBT (N= 40)	73 year-old man status post stroke with aphasia and left hemiparesis, coronary disease status post coronary artery bypass graft, and chronic obstructive pulmonary disease, who had screening at a preventive visit despite physician note indicating patient had < 5 year life expectancy and did not recommend screening. His physician recommended against further work-up and he progressively declined and died in 2002 in hospice.	Net Burden
2) Had other work-up after +FOBT (N=54)	80 year-old man with gout and arthritis who had a positive FOBT in 2001, followed by repeat negative FOBT in 2004. He never had follow-up colonoscopy. He moved to a VA nursing home in 2007 and remains alive.	Net Burden