Providing Screening Choices Improves Adherence to Colorectal Cancer Screening
Individuals are much more likely to get screened for colorectal cancer when given a choice between colonoscopy and fecal occult blood test (FOBT), according to the results of a study published in the Archives of Internal Medicine.
Screening is crucial for the prevention and early detection of colorectal cancer. The American Cancer Society currently recommends that people at average risk of colorectal cancer begin being screened for colorectal cancer at the age of 50. Screening may need to begin at a much earlier age for people with a personal or family history of adenomatous polyps, FAP, HNPCC, colorectal cancer, or chronic inflammatory bowel disease.
There are several available screening strategies for colorectal cancer, including FOBT, which checks for hidden blood in the stool and colonoscopy, which is a more invasive procedure that requires patients to be sedated while a physician inserts a flexible camera into the rectum to examine the colon.
Colonoscopy has become the gold standard for colorectal screening because it allows the physician to view the entire colon and rectum and on average, need only be performed every 10 years. FOBT, on the other hand, must be performed on a yearly basis. Both tests are effective ways to screen for colorectal cancer; however, most doctors recommend colonoscopy.
This study included a racially diverse group of 997 people at average risk for developing colorectal cancer. The participants were randomized to receive recommendation for screening with FOBT, colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome of the study was completion of colorectal screening within 12 months and secondary analyses evaluated the sociodemographic factors associated with completion of screening.
The results—when given a choice of screening method, 69 percent of people get screened within the year. In contrast, when the doctor recommended colonoscopy, only 38 percent of people followed through with screening. When FOBT was recommended, 67 percent of people completed the screening test. Overall, when given a choice, 31 percent of people chose colonoscopy and 38 percent chose FOBT.
The researchers found that cultural influences may play a role in adherence to colorectal screening. In this study, African-American, Latino, and Asian participants preferred the FOBT, while white participants more often adhered to colonoscopy.
The bottom line—one size does not fit all when it comes to colorectal cancer screening. Universally recommending colonoscopy may actually be reducing compliance to colorectal cancer screening, especially among ethnic minorities. Providing choices may improve colorectal cancer screening rates.
 Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: A randomized clinical trial of competing strategies. Archives of Internal Medicine. 2012; 172(7):575-582.
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