While it is known that patients with few primary care doctor's office visits are less likely to receive colorectal cancer screening, new research indicates that even patients who see their physicians regularly also do not receive screening.
The study, which appears in the February issue of Cancer Epidemiology Biomarkers and Prevention, was conducted by a team of researchers at UC Davis, the University of Washington and Group Health Cooperative in Seattle.
"Colorectal cancer screening is not on the primary care agenda as much as it should be," said lead author Joshua Fenton, assistant professor of family and community medicine at UC Davis. "Opportunities are being missed."
Fenton and his colleagues reviewed records of nearly 50,000 men and women aged 50 to 78 who were eligible for colorectal cancer screening in 2002 and 2003 and enrolled in Group Health Cooperative — a large, prepaid, nonprofit health plan that coordinates care and coverage in Washington state.
Most screening tests are ordered by primary care physicians, so the investigators were not surprised to find that patients with very few primary doctor's office visits received little or no colorectal cancer screening. The team was more surprised, however, to discover that more than half of patients with frequent primary care visits — four or more per year — also did not get screened.
"Merely encouraging people to see their doctors won't increase screening," said Fenton. "Screening saves lives. We have to do more to make sure that eligible patients are identified during primary care visits and counseled about options."
The study authors advocate a number of tested ways to increase the likelihood that colorectal cancer screening is recommended in primary care settings, including educational programs for patients and doctors, reminder systems, financial incentives and doctor's office visits dedicated to preventive care.
Fenton explained that the history of breast cancer screening, which also used to be underutilized, can serve as a model for colorectal cancer screening.
"Today, women know to ask for breast cancer screening and doctors are accustomed to recommending it. It's become part of standard practice. Hopefully, we'll also get to that point with colorectal cancer screening. It's more common throughout the nation than it was 10 years ago, but we've still got a long way to go," he said.
It is estimated that there were 148,810 people diagnosed with and 49,960 deaths from cancer of the colon and rectum in 2008. Screening for the disease contributes to reducing these numbers by leading to the early removal of polyps that could later become cancerous.
The study was supported by grants from the National Cancer Institute, the American Cancer Society and an HMO Cancer Research Network pilot grant. In addition to Fenton, study authors were Peter Franks of UC Davis; Robert Reid and Diana Buist of Group Health Cooperative; and Laura-Mae Baldwin and Joann Elmore of the University of Washington.
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