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Many New Yorkers Skip Colon Cancer Screening

Findings may reflect national trends, researchers say

MONDAY, July 25, 2005 (HealthDay News) -- Just slightly more than half of New York City residents over the age of 50 undergo timely colorectal cancer screenings as recommended by experts, a new study suggests.

According to researchers, that means an estimated one million Big Apple adults are currently at risk of living with undetected colorectal malignancies.

The finding is especially disheartening since New York City has one of the largest concentrations of gastroenterologists in the United States.

"We're not lacking in hospitals and out-patient clinics or experts to perform screening procedures," noted lead researcher Lorna E. Thorpe, deputy commissioner of health with the NYC Department of Health and Mental Hygiene (NYC DOHMH) in the division of epidemiology. "But colon cancer screening is underutilized nationwide, so our low rates of screening in New York are probably similar to the national average."

According to the American Cancer Society, 95 percent of cancers of the colon or rectum begin in the tract's lining, usually manifesting as tissue growths called polyps. Because colorectal cancer typically takes years to develop, screening that allows doctors to identify and remove these pre-cancerous polyps can prevent cancers.

Current city-wide guidelines -- set by NYC DOHMH in 2003 -- advise that otherwise healthy men and women over 50 years of age get a colonoscopy exam once every 10 years.

A colonoscopy involves the insertion through the rectum of a long, video-equipped tube of finger-size thickness that allows the physician to examine the colon for evidence of cancerous or pre-cancerous changes.

For patients unwilling to undergo colonoscopy, the city recommends a less optimal alternate screening method called the annual fecal occult blood test, in which stool samples are analyzed for evidence of blood.

National guidelines (such as those of the American Cancer Society) may also include the option of a sigmoidoscopy exam. In sigmoidoscopy, doctors use a shorter device to examine only the lower portion of the colon.

Reporting in the Sept. 1 issue of Cancer, Thorpe and her colleagues analyzed the results of a 2003 phone survey of almost 10,000 adult New Yorkers from all boroughs and ethnicities.

Respondents were asked about their health status, health insurance coverage, general health behaviors, preventive medical care experience and cancer-related screening habits. Income, race and educational backgrounds were also noted, as were physical activity routines and whether or not the individual smoked.

Among the more than 3,600 men and women 50 years of age or older, only 55 percent said they had undergone a colorectal cancer screening in the recommended time frame, the researchers report.

That percentage rose to 60 percent among those of all races over the age of 65. However, while 60 percent of whites of all ages were found to have sought appropriate screenings, the figures dropped to 52 percent among blacks and Hispanics and to just 36 percent among Asian men and women.

Men were overall more likely to have either a colonoscopy or sigmoidoscopy than were women, with older men more likely to undergo either of these screens than older women.

Thorpe and her team found that the gender gap was most striking among Asians, noting that Asian men were two times more likely to be screened than were Asian women.

In general higher income levels, higher educational achievement, greater engagement in healthy activities, and greater use of preventive healthcare were all associated with being more likely to get a colorectal screening. Those who smoked were less likely to seek screenings, and only 24 percent of those with no health insurance had undergone timely screenings.

According to the researchers, many of the one million unscreened New Yorkers at-risk for colorectal cancer were likely to be poor, uninsured, Asian, women, and/or smokers.

The American Cancer Society estimates that more than 140,000 men and women are diagnosed with colorectal cancer across the United States each year, and more than 50,000 die from the disease annually.

Colorectal cancer screening is extremely effective in detecting cancer early, the researchers note, leading to significant reductions in mortality. And they added that the exams are even more cost-effective than breast or cervical cancer screenings.

"If we had screenings in the 80-90 percent range, we could be saving thousands of lives just here in NYC," said Thorpe, who believes the New York statistics are reflective of a broader national problem.

"This is a cancer that we can do something about," she said. "It's probably the most effective cancer screening that we have -- more effective than a mammography or a pap smear, which are much more commonly utilized. So this is the only cancer that we can actually screen to prevent, not only screen to detect."

Dr. Judith Collins, section chief of gastroenterology at the Veterans Affairs Medical Center in Portland, Oregon, agreed.

"This is an important public health issue," Collins said. "We're talking about people's feces or someone looking in your colon, so perhaps it's not socially acceptable and it's not perceived as very pleasant. But people have done a great job of promoting mammography, and this is probably ... just as critical. So we need to do a better job of education, to decrease fears and concerns and reemphasize the importance of getting screened for colon cancer."

More information

For more on colon cancer, check out the American Cancer Society.

SOURCES: Lorna E. Thorpe, PhD, deputy commissioner of health, NYC Department of Health and Mental Hygiene, Division of Epidemiology , New York City; Judith Collins, MD, section chief, gastroenterology, Veterans Affairs Medical Center, Portland, Oregon and associate professor, medicine, Oregon Health and Sciences University, Portland; September 1, 2005 Cancer.
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