Colon cancer is the third leading cause of cancer death in men, but according to a new University of Michigan Health System study, fewer than half of men surveyed were up-to-date with colon cancer screenings.
What men do pay attention to is prostate cancer. And that has researchers thinking an annual prostate cancer screening might be a good opportunity to urge men to be screened for colon cancer too.
Researchers looked at 22,617 men age 50 and older who had responded to the 2002 Behavioral Risk Factors Surveillance Survey, an annual phone survey of adults that measures preventive health behaviors. The study found that while nearly two-thirds of men were up-to-date with prostate cancer screening, only 47.6 percent had had a recent colon cancer screening.
More than 70,000 men will be diagnosed with colorectal cancer this year, according to the American Cancer Society; some 28,000 will die from the disease. Experts recommend people age 50 and older get a fecal occult blood test annually, sigmoidoscopy every five years or colonoscopy every 10 years. These tests are highly effective at catching the disease early and reducing deaths.
The screening test for prostate cancer, called the prostate specific antigen, or PSA, test, is more controversial. Experts continue to debate what PSA level is cause for follow-up, and research suggests the test has not led to fewer deaths from prostate cancer.
"Colon cancer screening is proven to be effective at reducing deaths from colon cancer, while the effectiveness of the PSA test in reducing mortality continues to be debated. If we can turn the PSA test into an opportunity to encourage men to get their colons checked too, it would take advantage of the public demand for PSA testing," says lead study author Ruth Carlos, M.D., assistant professor of radiology at the University of Michigan Medical School.
In the study, which appears in the February Journal of the American College of Surgeons, researchers found men who adhered to colon cancer screening guidelines tended to be older and had a higher income level and more education than men who did not follow screening guidelines. One-third of men who said they regularly have the PSA test were not up-to-date with their colon cancer screening.
Carlos has previously looked at women's adherence to colorectal cancer screenings and compared it to mammograms to screen for breast cancer and Pap smears to check for cervical cancer. That research found only half of women who got regular mammograms and Pap smears also had a colonoscopy or other colon cancer screening.
Carlos is currently leading a clinical trial that randomizes women to receive education during their mammogram appointments about either colorectal cancer screening or diabetes screening. The researchers will review the women's records up to a year later to see if they get checked for colon cancer or spoke to their physicians about it.
If successful, Carlos says, the same approach could be taken for men during prostate cancer screenings.
"Men are already paying attention to their cancer risk in one area. If we can take advantage of that consciousness to educate them about another cancer risk, it might lead to more early detection of colorectal cancer," Carlos says. Research has shown these "teachable moments" are more effective than untimed formal interventions at changing health behavior.
The researchers also suggest targeting information on colon cancer to the type of patient less likely to be screened for the disease. The study found men who were not compliant were younger, were Hispanic, had lower education and income levels, and were smokers. Outreach efforts could focus on predominantly Hispanic neighborhoods or be combined with smoking cessation programs, for example.
In addition to Carlos, study authors were Willie Underwood III, M.D., assistant professor of urology; A. Mark Fendrick, M.D., professor of internal medicine; and Steven Berntsein, M.D., M.P.H, associate professor of internal medicine.