Elderly Avoiding Colorectal Cancer Screening

Many on Medicare don't seek help until symptoms appear, study shows

MONDAY, Jan. 10, 2005 (HealthDayNews) -- Less than half of the Medicare patients diagnosed with colorectal cancer had any screening in the six months before being diagnosed, troubling new research shows.

In addition, almost 94 percent of them had never had a colonoscopy until the one that diagnosed their cancer, according to the report in the Jan. 10 online issue of Cancer.

"Even though colorectal screening is recommended, among patients with cancer, only a minority of them underwent a screening procedure," said study author Dr. Gregory S. Cooper, an associate professor of medicine and epidemiology at Case Western Reserve University. "Most of the procedures that were done were those that lead to the cancer diagnosis."

Had patients been screened regularly, Cooper added, many would have had their cancer caught early enough for successful treatment.

In their study, Cooper and his colleague, Jonathan D. Payes, collected data on 5,806 men and women aged 70 and older who were diagnosed with colorectal cancer.

Cooper and Payes found that only 44 percent of these patients had had a screening test more than six months before they were diagnosed.

The most common screening test was the fecal occult blood test (FOBT). "This is the most widely available test, and least expensive," Cooper said. "But is also the least accurate."

Most patients (63 percent) had undergone a colonoscopy, but most of those were done only at the time of or shortly before their cancer diagnosis. Only 6 percent had a colonoscopy more than six months before being diagnosed with cancer.

Moreover, those patients who had been screened had early-stage disease, which is usually more treatable, Cooper and Payes noted. "Patients who did have a test done compared to the ones who didn't were less likely to come in with advanced-stage cancer," Cooper said.

Cooper believes people are reluctant to undergo colorectal screening. "It hasn't gained the popularity that Pap testing or mammography has. People don't like talking about their bowels, and there is an inherent resistance to get testing done," he said.

There is not enough screening being done, Cooper added. "Screening is potentially a lifesaving procedure. It will either prevent you from getting cancer, or if it does pick up cancer, it will be at an earlier more curable stage," he said.

Cooper suggests that if you haven't been screened before, you should bring it up with your doctor. "There are a variety of different options," Cooper said. The best is colonoscopy. "But there are other tests that may not be as accurate as colonoscopy, but they're certainly better than doing nothing," he noted.

"This is something I see all the time," said Dr. Joseph Martz, an attending physician in the department of colorectal surgery at Beth Israel Medical Center in New York City. "Unfortunately, most people who present with colorectal cancer are presenting with cancer because of bleeding or obstruction."

Although the patients in this study were 70 and older, Martz said the same findings apply to patients 50 and older.

Martz recommends that everyone undergo some form of screening at 50. "However, nothing compares to the gold standard of colonoscopy," he added.

The current recommendation for colonoscopy is to have one every 10 years. "Unfortunately, we know that the polyp-to-cancer progression is between two to five years," Martz said. "My personal recommendation is to have one at least every five years. Patients who have had a history of polyps or a family history of colon cancer should have one every three years."

"It is a problem in this country that screening for colorectal cancer is not well integrated in primary care," said Robert Smith, director of cancer screening at the American Cancer Society.

Early detection not only makes colorectal cancer more curable, but also is likely to prevent a recurrence of cancer, Smith added.

"There needs to be greater emphasis in integrating colorectal screening in primary care," Smith said. "And we are seeing progress in that area."

More information

The American Cancer Society can tell you more about colorectal cancer.

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