Colorectal cancer screening underutilized

Fewer than half of patients diagnosed with colorectal cancer had received a screening procedure at least six months prior to their diagnosis, according to a new study. Researchers writing in the February 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, further say almost 94 percent of colorectal cancer patients had either not undergone a colonoscopy at all, or not until having the procedure that led to their diagnosis.

Professional societies unanimously recommend colorectal cancer screening in older adults. The premise is mortality and morbidity is reduced when a premalignant growth, which is generally at an earlier stage, is detected and treated. Clinicians can use tests as simple as the fecal occult blood test (FOBT), which is the cheapest but least sensitive test, to tests that examine part of the colon with the sigmoidoscopy, or all of it with a colonoscopy or barium enema. The colonoscopy is the most sensitive test.

In order to characterize the use of the various screening tests in the population and their association with cancer stage, Gregory S. Cooper, M.D. and Jonathan D. Payes, M.S. of the University Hospitals of Cleveland and Case Western Reserve University reviewed the screening history and cancer stage of 5,806 elderly patients diagnosed with colorectal cancer.

The authors found fewer than half (44 percent) of patients had received at least one screening test more than six months prior to diagnosis, and most often that test was FOBT. While colonoscopy was the most common test overall (63 percent of patients), most were done within six months of diagnosis, with only 6 percent performed prior to the six-month period before diagnosis. Patients with a history of screening more than six months prior to diagnosis had earlier stage and presumably more treatable disease.

The authors conclude, “we have highlighted the underuse of colorectal procedures in clinical practice, which is relevant given the high incidence and mortality of colorectal carcinoma in the United States.”