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CDC: Too Many Skip Colon Cancer Screening Tests

7:04 PM, Nov 5, 2013   |    comments
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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.

But 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 Arkansas.

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.

Colonoscopy, 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.

According to the report, many providers believe that colonoscopy is the best test option and do not offer other screening tests to their patients.

The 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 (0.7%).

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."

Most 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 Duarte, Calif.

"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 screened.

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