What Is patientINFORM?

Summary: More Americans are getting the message that colorectal cancer screening is important. Researchers from the National Cancer Institute and the University of Texas, Houston, say screening rates have increased among men and women over the past few years. But the rates still aren't where they need to be, experts say.

Why it's important: Colorectal cancer is a major killer of both men and women in the United States. It is expected to strike nearly 150,000 people in 2006, and kill more than 55,000. Yet this cancer is largely preventable. Screening can help find colon growths called polyps so they can be removed before they ever turn into cancer. It can also detect cancer early, when it is easier to treat. Because screening can save lives, getting more people tested is a public health priority.

"Rates of colorectal cancer screening should be as good as or better than mammography rates if the nation really wants to gain the greatest level of benefit from both a prevention and early detection standpoint," said Durado Brooks, MD, director of prostate and colorectal cancer for the American Cancer Society.

What's already known: Despite the lifesaving potential, only a fraction of people who should be screened for colon cancer actually get the tests they need. The American Cancer Society recommends that adults begin regular colorectal cancer screening at age 50, or earlier if they are at high risk of developing the disease. In the year 2000, though, only 42% of eligible adults in the US had one of the recommended tests. By contrast, between 1999 and 2003, about 70% of US women had mammograms.

How this study was done: The researchers looked at several years' worth of answers from the National Health Interview Survey, a yearly government survey of thousands of US residents. The survey includes questions about the use of several types of colorectal cancer screening methods. The researchers looked at how screening patterns changed over time. Their findings appear in the journal Cancer Epidemiology, Biomarkers & Prevention.

What was found: The researchers found an increase in screening between 2000 and 2003. This bump was largely caused by more people getting colonoscopy. Overall, about 47% of men and 43% of women reported getting some kind of colorectal cancer screening test. People over 65 had higher rates of screening, perhaps because the procedure is covered by Medicare. People who had health insurance and those with a primary care doctor were also more likely to get screened.

Brooks said other national health surveys have also shown an increase in colorectal cancer screening rates.

"It's good news that the rates are going up in whatever fashion, by whatever test," he said. "But it's concerning that we're still falling far short of screening rates for other cancers."

The bottom line: The researchers worry that a recent heavy focus on colonoscopy could make people forget that there are other tests they can get to find colorectal cancer early. Brooks said choosing any of the recommended screening methods is better than not getting screened.

"There's nothing wrong with colonoscopy as long as patients have access to it and are willing to go through with the test," he said. But if patients can't or won't get colonoscopy, "we need to make sure they're being offered other testing options."

Besides colonoscopy, ACS recommends flexible sigmoidoscopy, double contrast barium enema, fecal occult blood test (FOBT), or fecal immunochemical test (FIT) as possible screening methods.

"Testing by any of the available recommended methods is a reasonable choice," Brooks said. "The only unreasonable choice is not to be tested."

Citation: "Patterns of Colorectal Cancer Screening Uptake Among Men and Women in the United States." Published in the Feb. 2006 Cancer Epidemiology, Biomarkers & Prevention (Vol. 15; No. 2: 389-394). First author: Helen I. Meissner, ScM, PhD, National Cancer Institute.