Each year in the United States, colorectal cancer causes over 50,000 deaths. Despite the obvious seriousness of colorectal cancer, a new study published in the Journal of General Internal Medicine reports that 81 percent of doctors are not following all recommended colon cancer screening guidelines. While approximately 40% of doctors follow guidelines for some tests, a shocking 40% don’t follow recommended guidelines for any colon cancer screening tests.
First off, what are screening tests? A screening test is a test for a certain disease that is given to patients who do not have symptoms of the disease. This is different from a test that a doctor orders in response to a specific symptom, e.g., a finding of blood in the stool that results in a colonoscopy to discover the cause of the bleeding. The purpose of a screening test is to catch a disease early, before it gets to the point where it starts to cause symptoms. The earlier colon cancer gets detected, the better chance the patient has for a successful outcome. Knowing this, it is difficult to understand why doctors are not following recommended guidelines.
One factor that the study’s authors noted was the age of the doctor. Younger, board-certified doctors were the most likely to properly follow the guidelines. Older doctors, on the other hand, were less likely to do so. It appears that older doctors may be following guidelines that were in effect at the time of their training rather than keeping up to date with current guidelines. This is not to suggest that the non-compliant doctors are all failing to recommend any screening tests. The study indicates that some doctors are actually over-using the tests. This, however, can result in additional risk (e.g., risk of injury from a colonoscopy) as well as unnecessary tests and higher medical costs.
From the patient’s perspective, it is wise to know yourself what the recommended guidelines are so that you can have a meaningful discussion with your doctor about what tests you should be getting and when. As reported in the linked article:
Here are the American Cancer Society’s current guidelines on checking for colorectal cancer and polyps (often precursors to cancer). Starting at age 50, men and women should follow one of these testing schedules:
To detect both polyps and cancer (preferred) :
- A flexible sigmoidoscopy every five years or a colonoscopy every 10 years (sigmoidoscopy examines the lower part of the colon, colonoscopy is more extensive)
- double-contrast barium enema once every five years
- or CT (“virtual”) colonoscopy once every five years
To primarily detect a cancer:
- Fecal occult blood test (gFOBT) or fecal immunochemical test (FIT) every year
- Stool DNA test (SDNA), interval as yet uncertain
Some people may require a different screening schedule due to personal or family history; the cancer society recommends that you talk with your doctor to determine which schedule is best for you.