Cancer Screening

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Talking About Choices May Encourage Colon Cancer Screening

By: Kamal Menghrajani

Doctor greating patient

Patient-doctor discussions about choices in colon cancer screening may encourage more people to follow through. (Vic Lawrence: Flickr)

Although about 50,000 people in the U.S. died from colorectal cancer (CRC) last year, as many as half of those deaths could have been prevented by routine screening. That’s 25,000 lives that could have been saved using tools that are already widely available.

The problem is getting people to undergo screening can be a bit of a challenge. The “ick” factor of colonoscopies, concerns about paying for them, and other barriers get in the way of adequate screenings. Alternatives do exist, such as the fecal occult blood test (FOBT) – a non-invasive test people can do at home and send into the lab. As reported here in the past, new tools are also being developed that use more advanced science to check for markers of cancer, though these are still gaining traction.

But now doctors are looking at the psychology of how they talk to patients to figure out what might get the most people to get on board with screening.

In a study published today in the Archives of Internal Medicine, researchers from three medical schools, including UCSF, focused on just colonoscopies and FOBT. The study was done in San Francisco through the Community Health Network, and randomized doctors into three study groups: one to recommend only FOBT, one to recommend only colonoscopy, and one to offer patients a choice between the two.

Researchers presumed that recommending just one or the other would send a clear signal and be more effective than giving patients a choice.

They were wrong.

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Avoiding a Colonoscopy? You’re Not Alone

If the sight of a colonoscope like this one makes you shudder, there are other options for colorectal cancer screening.

Colorectal cancer is one of the five most common cancers in both men and women, and it kills more than 43,000 Americans each year. As we learned today, colonoscopy is a successful screening method–it cuts the death rate of colorectal cancer in half.

Still, getting a colonoscopy has a problem: the yuck factor. That’s why a study in today’s New England Journal of Medicine caught my eye. Researchers in Spain looked at colonoscopy versus “FIT,” a non-invasive test to screen for colorectal cancer. FIT–fecal immunochemical testing–looks for the presence of blood in the stool, a marker for benign polyps or cancer. Patients have either one colonoscopy during the ten years of the study or FIT every other year. (Note that the American Cancer Society has a great explainer of the different screening methods available and pros and cons of each).

“In order to get a large proportion of a population screened, you have to offer an alternative to colonoscopy.”
In today’s study researchers say colonoscopy and FIT detected roughly the same number of cancers. The report comes at the two year point of what will be a ten year study. We have to wait the full ten years to see how death rates from colorectal cancer compare between the two types of screening. Continue reading

Should Older Adults be Screened for Cancer?

(Jason DeRusha: Flickr)

(Jason DeRusha: Flickr)

Right about now, you might be thinking you’ve heard enough of cancer screening. From mammography to prostate cancer, cancer screening tests have been much debated this fall. Should a 40 year old woman get a mammogram or not? Should men abandon the PSA test? Yet another study released this week looks at a surprisingly unexplored group–older Americans.

Researchers wanted to look at this group because of an “ambiguity of recommendations” for them. While it seems like there’s some ambiguity for the rest of us, the ambiguity here is particularly surprising since age is perhaps the most significant risk factor for many cancers.

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