A commonly held view is that colon cancer screening is embarrassing, even disgusting. Talk of bowel movements, laxatives and enemas offends people. So, how successful has the medical establishment been in recent years in overcoming this cultural bias?
As recently as 2000 national surveys suggested that fewer than fifty percent of United States adults over the age of fifty were undergoing any kind of colorectal cancer screening. The highest compliance rate reported was from the Kaiser Permanente Plan in California, whose doctors are scored on the quality of the care they deliver. In their hands about sixty percent of their patients had some sort of screening event, usually fecal occult blood testing (FOBT, the three-card test on stool). A much smaller percentage had any kind of invasive procedure such as barium enema or colonoscopy even though these tests are much more accurate than FOBT. Nationally the numbers were lower.
Ever since Katie Couric underwent a colonoscopy on national television, the colorectal community – gastroenterologists, colorectal surgeons and oncologists – has pushed to bring screening to the forefront. For over a decade March has been dedicated to increasing public interest in colon cancer screening.
How have we done?
From: Cancer Epidemiol Biomarkers Prev 2006;15:389-394
The above graphs look at screening over a sixteen-year period ending in 2003. Clearly the message is getting across. The graphs are complicated by the fact that the questionnaire used to query the population evolved over time – hence the discontinuous curves. Nonetheless there is a clear trend upward over the years measured. More recent data are not available yet but one would hope that the trend is continuing upward.
Fortunately there are robust data to support the efficacy of colorectal screening in reducing mortality from this disease. Even FOBT, the easiest and cheapest screening modality, reduces mortality dramatically. The goal of any of these modalities is to find colon cancer before it begins – when it is still a polyp. Experience has shown that this can be accomplished. Large randomized trials show that patients screened have a much lower incidence of advanced cancer when diagnosed than patients whose cancer was diagnosed because of symptoms.
Lives are saved with colorectal cancer screening. If you are over fifty or have other risk factors for colon cancer get screened! Your life may depend on it.