case western reserve university



Study finds colorectal cancer screening underused

Fewer than half of patients diagnosed with colorectal cancer had received a screening procedure at least six months prior to their diagnosis, according to a new study from the Case Western Reserve University School of Medicine and University Hospitals of Cleveland (UHC).

Researchers writing in the February 15, 2005, issue of Cancer, a peer-reviewed journal of the American Cancer Society, further say that almost 94 percent of colorectal cancer patients had either not undergone a colonoscopy at all, or not until having the procedure that led to their diagnosis. The article is published online today.

Professional societies unanimously recommend colorectal cancer screening in older adults. The premise is mortality and morbidity are reduced when a pre-malignant growth, which is generally at an earlier stage, is detected and treated. Clinicians can use tests from the simple fecal occult blood test (FOBT), the cheapest but least sensitive test, to a direct examination of the colon with a sigmoidoscopy, a colonoscopy or barium enema. The colonoscopy is the most sensitive test.

In order to characterize the use of the various screening tests in the population and their association with cancer stage, Gregory S. Cooper, M.D., and Jonathan D. Payes, M.D., of Case and UHC, reviewed the screening history and cancer stage of 5,806 elderly patients diagnosed with colorectal cancer.

The authors found fewer than half (44 percent) of patients had received at least one screening test more than six months prior to diagnosis, and most often, that test was the FOBT. While colonoscopies were the most common test overall (63 percent of patients), most were done within six months of diagnosis. Only six percent were performed prior to the six-month period before diagnosis. Patients with a history of screening more than six months prior to diagnosis had earlier stage and presumable more treatable disease.

The authors conclude, “we have highlighted the underuse of colorectal procedures in clinical practice, which is relevant given the high incidence and mortality of colorectal carcinoma in the United States.”

Cooper is an associate professor of medicine and Payes is an analyst/programmer. Both are in the division of gastroenterology at Case and UHC.

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About Case Western Reserve University

Case is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work.