Many Doctors Not Using Colon Cancer Test Properly

THURSDAY April 15, 2010 -- Many American doctors don't make proper use of a colorectal cancer screening method called the fecal occult blood test, a new study claims.

Researchers from the U.S. Centers for Disease Control and Prevention surveyed 1,134 primary care physicians and found that 75 percent of them order or perform an in-office fecal occult blood test (FOBT), rather than relying on the more accurate home-based FOBT.

National guidelines recommend that FOBT testing be done with stool samples collected at home. The in-office test -- in which a single stool sample is collected by a physician during a digital rectal examination -- is not recommended for colorectal cancer screening because it misses 95 percent of cancers or precancerous polyps.

"Many primary care physicians continue to use inappropriate FOBT methods to screen for colorectal cancer, thereby missing the potential to save lives," study author Marion Nadel, a health scientist in CDC's Division of Cancer Prevention and Control, said in an agency news release.

"FOBT is an important option for screening, but it must be implemented correctly. People who choose FOBT for screening should use high-sensitivity home tests on an annual basis and be sure to follow-up on any positive result," she added.

Among physicians who ordered or performed FOBT, 25 percent used in-office FOBT exclusively and about 53 percent used both in-office and home tests. The study also found that 61 percent of doctors used the standard guaiac-based FOBT, while significantly fewer used the sensitive guaiac-based test and the fecal immunochemical tests. Those high-sensitivity tests are much more effective at detecting colorectal cancer and advanced lesions.

One positive finding was that 93 percent of the physicians said they used colonoscopy as a follow-up to a positive FOBT, as recommended in national guidelines.

The study was published online April 10 in the Journal of General Internal Medicine.

Colorectal cancer screening is recommended for people aged 50 and older. Certain people may need to begin screening at a younger age. Along with FOBT, other recommended screening tests for colorectal cancer are flexible sigmoidoscopy (every five years) and colonoscopy (every 10 years).

More information

The U.S. National Cancer Institute has more about colorectal cancer screening.

Posted: April 2010


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