Many Patients Skip Recommended Colonoscopy: Study

TUESDAY April 10, 2012 -- Although a colonoscopy is considered the "gold standard" for colon cancer screening, a new study finds that many patients are reluctant to have the test.

Patients are more likely to opt for a simple fecal occult blood test -- a brief part of a medical exam -- that checks for bleeding, which can be a sign of colon cancer, the researchers said.

"The best test is the one that the patient actually performs," said lead researcher Dr. John Inadomi, a distinguished professor and head of the division of gastroenterology at the University of Washington, in Seattle.

"We should not assume that all patients prefer colonoscopy; therefore, patient preferences should be elicited to determine the test to which they are most likely to adhere," he said.

The main difference between the two tests, Inadomi said, is that a fecal occult blood test should be done every year, while for most people a colonoscopy can be done every 10 years starting at age 50.

In addition, any cancerous or precancerous polyps found during a colonoscopy can be removed during the procedure. If a fecal occult blood test proves positive, a colonoscopy is the next step.

The downside of a colonoscopy for many patients is the preparation, which involves fasting and using laxatives the day before the procedure. Many patients also don't like being sedated, and there can be complications, particularly a puncture of the intestine cause by the instrument, Inadomi said.

The report was published in the April 9 issue of the Archives of Internal Medicine.

For the study, 997 men and women were assigned to or given a choice of having a colonoscopy or a fecal occult blood test.

Within a year, 58 percent of the participants had the selected screening test.

Only about 38 percent of those who chose or were assigned to a colonoscopy actually had one, however, compared with more than 67 percent of those who were assigned to or chose a fecal occult blood test, the researchers found.

Significant racial/ethnic differences existed in screening, with whites more likely to have a colonoscopy and nonwhites a fecal occult blood test, the researchers found.

Blacks had the lowest rate of colon cancer screening at 48 percent. Asians and Latinos -- at about 61 percent and 63 percent, respectively -- had the highest rates, the study found.

"We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."

Levin said there are many alternatives to colonoscopy, such as a virtual colonoscopy or sigmoidoscopy, and often when people are given too many choices they end up not doing anything.

"People may become confused and more likely to do nothing, but if you offered them colonoscopy, a test they don't want to do, or another test like a fecal occult blood test, then they are more likely to be screened," he said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about colonoscopy.

Posted: April 2012


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