Americans Not Getting Lifesaving Screenings Often Enough

Confusion, procrastination play a part in delays, survey finds

SUNDAY, May 30, 2004 (HealthDayNews) -- Maybe, like many Americans, you've put off getting that cholesterol test. Or colonoscopy. Or Pap Smear.

Well, maybe you shouldn't wait any longer.

A large percentage of the U.S. public remains confused about tests that spot high cholesterol and detect the early signs of cancer, experts say, but that confusion could become deadly.

It's not that Americans don't understand that regular screening is important: 98 percent of those polled in a recent Gallup survey agreed screening for cancer or cholesterol can and does save lives.

Unfortunately, the poll also found that only a small percentage of respondents actually get tested.

In too many cases, "if people felt healthy they weren't sure that they really needed to go see their doctor," said Dr. Paula Szypko, a spokeswoman for the College of American Pathologists, which sponsored the recent poll of 1,500 adults.

The survey reveals deep misunderstandings about the nature and timing of various screening procedures.

For example, experts now recommend that all adults over 20 years of age get their cholesterol checked at least once every five years, with screening frequency increasing in middle age.

"What's bothersome is that relatively few young people are being screened for cholesterol," Szypko said. She notes a definite "age gap" between those over and under 40 years of age. While a majority of poll respondents over 40 said they went for regular cholesterol check-ups, most under 40 said they had never gone for the simple blood test.

Another disheartening surprise, Szypko said, was that "doctors weren't always recommending cholesterol checks in the younger population." When asked if their doctor had ever advised them to get the test, "67 percent of women under 40 said 'no,' along with 71 percent of men under 40," she said.

Dr. Michael S. Lauer is a heart expert with the Cleveland Clinic Foundation. He said it's "not at all surprising" that most young Americans are foregoing cholesterol checks, since "the reality is that for most people under the age of 30, the risks are really very low."

Still, high cholesterol remains a major risk factor for heart disease, and young people -- especially the diabetic, obese and those with a family history of heart disease -- would do well to go for regular cholesterol screenings, he said.

Confusion and procrastination may be keeping people from getting regular cancer screenings, too. For example, 91 percent of men over 50 interviewed in the poll agreed that regular colorectal screening could save their lives. However, just 54 percent said they had ever gone for screening.

Current guidelines recommend that all Americans over 50 years of age receive stool-based colon cancer screenings annually and a full colonoscopy once every 10 years, to help detect precancerous colon polyps.

"This is an important age to start getting colon cancer screening," Szypko said. "If someone waits till there are symptoms it may already be too late." She believes many patients may be hesitant to get a colonoscopy because of exaggerated fears that it is embarrassing and uncomfortable. In fact, the test is almost always conducted while the patient is sedated, and most who have had it "don't really think it's a big deal," Szypko said.

Surprisingly, many women responding to the Gallup survey appeared confused about one of the oldest, most trusted and most effective cancer screens currently available: the Pap smear.

Less than half of women -- 48 percent -- correctly identified the Pap test as a tool used by doctors to spot cervical cancers or precancerous lesions of the cervix. According to Szypko, many believe instead that the test is designed to spot sexually transmitted diseases such as chlamydia, gonorrhea or even HIV.

"Also, some women (13 percent) thought they were looking for ovarian cancer or endometrial cancer," Szypko said. These misconceptions are dangerous because if women suspect they have an STD there are tests specifically designed to diagnose those infections. There are currently no tests for the early detection of either ovarian or endometrial cancer.

There was some good news from the poll, however. "We're doing a pretty good job with mammograms," Szypko said. "We do find that a lot of women know that they need to be having annual mammograms, and they are getting them." In fact, more than 70 percent of women interviewed were in compliance with current screening guidelines.

Still, some women appeared to be confused about just when they should start going for annual breast cancer screening. "We currently recommend that women start having them by age 40," Szypko said, "but a lot of the women surveyed (53 percent) thought that they ought to be having them by age 30. And that isn't necessary unless there's a strong family history."

All in all, more work needs to be done to clear up the confusion, she said, "and to help people to remember to go get some of these tests. To that end, the College of American Pathologists has set up a patient e-reminder.

"By logging on to that site, anyone can choose the date to have an e-mail message sent to them, reminding them to schedule some of these important tests," Szypko said.

More information

Visit the University of Maryland School of Medicine to find out more about cholesterol screening, and the American Cancer Society for guidelines on early detection for cancer.

SOURCES: Paula Szypko, M.D., pathologist, High Point, N.C., and spokeswoman, College of American Pathologists; Michael S. Lauer, M.D., director, clinical testing, department of cardiovascular medicine, Cleveland Clinic Foundation, Cleveland; March 24, 2004, Gallup poll, Patient's Perceptions Regarding Preventive Testing
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