Reasons for low colorectal cancer screening rates

Dec 18 2007

Two recently released studies confirm an alarming reality, that a majority of Americans who should be getting screened for colorectal cancer are not.

Men and women over the age of 50 should be screened for colorectal cancer, but according to a study in the journal Cancer, researchers found that among an assessment of Medicare beneficiaries between 1998 and 2004, only 25.4 percent of people were screened, despite Medicare coverage for colorectal cancer screening. According to figures released by the Agency for Healthcare Research and Quality, only half of all Americans age 50 and over have had a screening colonoscopy.

“These numbers are very discouraging and, unfortunately they confirm previous studies that show not enough people are getting screened for colorectal cancer. This disease is preventable and treatable when caught in its early stages, and screening is a covered benefit for those eligible for Medicare,” said Grace Elta, MD, president of the American Society for Gastrointestinal Endoscopy (ASGE). “We know that screening works. According to a recent study by leading cancer groups, including the American Cancer Society and the CDC, deaths from colorectal cancer dropped nearly 5 percent between 2002 and 2004. Prevention through screening and the removal of precancerous polyps were among the reasons credited for the decline. The ASGE encourages all people age 50 and older to talk to their doctor about getting screened for colorectal cancer.”

Colorectal cancer is the third most commonly diagnosed cancer in men and women and the second leading cause of cancer-related deaths in the United States, killing nearly 56,000 people each year. Many of those deaths could be prevented with earlier detection. The five-year relative survival rate for people whose colorectal cancer is treated in an early stage is greater than 90 percent. Unfortunately, only 39 percent of colorectal cancers are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the five-year relative survival rate decreases dramatically.

ASGE screening guidelines recommend that, beginning at age 50, asymptomatic men and women at average risk for developing colorectal cancer should begin colorectal cancer screening. People with risk factors, such as a family history of colorectal cancer, should begin at an earlier age. Patients are advised to discuss their risk factors with their physician to determine when to begin routine colorectal cancer screening and how often they should be screened. Colonoscopy is a procedure which looks at the entire colon and plays a very important role in colorectal cancer prevention because it is the only method that is both diagnostic and therapeutic. Not only does colonoscopy view the entire colon, but it also removes polyps before they turn into cancer.

The Cancer study, published online December 10, looked at 153,469 cancer-free Medicare beneficiaries beginning in 1998, the first year Medicare began coverage for colorectal cancer screening. The beneficiaries included 17,940 patients with one or more risk factors for cancer and 135,529 “average risk” patients. Between 1998 and 2004, only 25.4 percent of patients were screened for colorectal cancer, this is down from 29.2 percent from 1991 to 1997, before Medicare coverage of colorectal cancer screening began. Researchers identified claims for various colorectal cancer screening methods including fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and barium enema.

Recently released figures from The Agency for Healthcare Research and Quality show that in 2005 only half of all Americans age 50 and over have had a screening colonoscopy. Nearly 67 percent of Hispanics age 50 and older reported never having had a colonoscopy screening, compared to 47.1 percent of Caucasians and 55.8 percent of African Americans. Age was found to be an issue in the study. Among those aged 50 to 64, 57.5 percent reported never having had a screening colonoscopy, compared to 39.4 percent of those aged 65 and older. Among those 65 and older, 41.6 percent of women versus 36.4 percent of men reported never having had a screening colonoscopy.

The ASGE notes that some reasons for low colorectal cancer screening rates include:

• Lack of public awareness about colorectal cancer and the benefits of regular screening
• Inconsistent recommendations for screening by medical care providers
• Uncertainty among healthcare providers and consumers about insurance benefits
• Concern about painful or embarrassing screening tests
• Hesitance to discuss "the disease down there"

The ASGE encourages all people aged 50 or older, and those with risk factors for colorectal cancer, to talk to their physician about getting screened for colorectal cancer.