The number of Americans who got tested for colorectal cancer rose
from 54% in 2002 to 65% in 2010, an increase driven primarily by
increased use of colonoscopy, a federal health report said Tuesday.
23 million people age 50 to 75 have not been screened by colonoscopy or
other test options. That puts them at increased risk for preventable
colon cancer, says the new report from the federal Centers for Disease
Control and Prevention.
And where people live affects the
likelihood of getting screened. State-by-state data from CDC's 2012
Behavioral Risk Factor Surveillance System survey show that compliance
with testing ranged from a high of 76.3% in Massachusetts to 55.7% in
Colorectal cancer is the second leading cancer killer
among men and women in the USA, after lung cancer, and the leading
killer among men and women who don't smoke, according to the CDC. More
than 50,000 people each year will die from colorectal cancer, the
leading killer of non-smokers in the country, Frieden says. Screening
tests can prevent cancer or detect it at an early stage, when treatment
can be highly effective.
"We're delighted to see a big increase in
colonoscopy screenings in recent years ... but there are effective
options in addition to colonoscopy," says CDC Director Thomas Frieden.
"We encourage health care providers to talk to their patients about
getting tested and about the choice of tests. The best test is the test
that gets done."
The U.S. Preventive Services Task Force, a panel
of medical experts mandated by Congress, recommends that adults 50 and
older should get tested with one or a combination of these colorectal
cancer screening tests:
• High-sensitivity fecal occult blood test
(FOBT) or fecal immunochemical test (FIT). These are at-home tests
that check for hidden blood in stool samples. Should be done every year.
• Flexible sigmoidoscopy,
in which a flexible, lighted tube (sigmoidoscope) is used to look at
the interior walls of the rectum and part of the colon. Should be done
every five years or every three years if done with the FOBT/FIT.
in which a flexible, lighted tube (colonoscope) is used to look at the
interior walls of the rectum and the entire colon. Should be done every
10 years. During the procedure, samples of tissue can be collected for
closer examination, or polyps (growths that shouldn't be there) may be
removed. Over time, some polyps can turn into cancer.
the report, many providers believe that colonoscopy is the best test
option and do not offer other screening tests to their patients.
report says that among respondents who were up to date with a
screening, colonoscopy was the most commonly used test (61.7%),
followed by FOBT (10.4%) and sigmoidoscopy in combination with FOBT
In cases in which there is a strong family history of
colon cancer, polyps or a history of certain diseases, such as
inflammatory bowel disease, colonoscopy is clearly preferred, says
Frieden. "However, for everyone else, and that's the great majority of
people, there is no proven benefit of one versus the other approach."
insurance plans and Medicare help pay for colorectal cancer screening
for people who are 50 or older. But "many people have not availed
themselves of something that generally is being offered for free. That's
the part that's really bothering us," says Donald David, chief of
gastroenterology at City of Hope, a comprehensive cancer hospital in
"People have a lot of misconceptions about this
kind of exam or think they have to wait for symptoms, but then it's not a
screening test," says David.
According to the CDC, the primary
reasons that people say they don't get screened is that their doctor
never informed them about it or they didn't know they needed to be