Study Shows Colorectal Cancer Screening Rates High in Patients with Multiple Health Problems

A study by University of Kentucky researchers showed that in Appalachia, colorectal cancer screening rates were higher in the population with multiple morbidities or diseases compared to those who had no morbidities at all.

Published in the Southern Medical Journal, the study used data based on a survey of 1,153 Appalachian men and women aged 50-76. Respondents were given four sets of questions designed to gather information on demographics; the presence of co-mordibities such as heart disease, diabetes, stroke, and various types of cancer; adherence to colorectal cancer screening guidelines; and barriers to and facilitators of colorectal cancer screening behavior.

Researchers found a dose-response relationship between the number of morbidities and the prevalence of colon cancer screening in the Appalachian population. Of those who reported two to three morbidities, 61.6 percent had received a colonoscopy; 65.7 percent had received a guideline-concordant colorectal screening. For patients with six or more morbidities, the rates rose to 69.6 percent and 79.6 percent, respectively.

In contrast, just 50 percent of those who reported no morbidities had undergone a colonoscopy, and only 56.5 percent had received any guideline-concordant colorectal screening.

The high screening rates in the multimorbid population were surprising, but it’s a strong indication that the efforts to raise awareness about the importance of colonoscopies and other screening methods is working, says Nancy Schoenberg, Marion Pearsall Professor of Behavioral Science at the UK College of Medicine and principal investigator of the study.

Reducing the number of deaths from colorectal cancer depends on detecting and removing precancerous colorectal polyps, as well as detecting and treating the cancer in its early stages.

- Colorectal cancer can be prevented by removing precancerous polyps (abnormal growths), which can be present in the colon for as many as 10 years before invasive cancer develops.

- When colorectal cancer is found early and treated, the 5-year relative survival rate is 90%. Because screening rates are low, less than 40% of colorectal cancers are found early.

- One U.S. clinical trial reported a 33% reduction in colorectal cancer deaths and a 20% reduction in colorectal cancer incidence among people offered an annual fecal occult blood test (FOBT).

“Over the past 10 years, there has been increasing coverage of the importance of colorectal cancer screening,” Schoenberg said. “We are probably at about the same screening rate for colorectal cancer now that we were for cervical cancer and breast cancer several decades ago. We hope that colorectal cancer screening will eventually become as commonplace and routine as Pap tests and mammograms.”

The higher screening rates in those with multiple health problems could also be due to more frequent contact with physicians, while residents who are otherwise healthy may not be visiting their physician as frequently, said Steve Fleming, associate professor of epidemiology at the UK College of Public Health.

Why screen for colorectal cancer?
-  Screening both prevents colorectal cancer and reduces mortality.
-  New insurance reporting requirements include your practice’s screening rates.
-  Malpractice cases involving colorectal cancer are costly.
-  Continuing medical education (CME) credit is available for practice improvement activities that focus on improved screening for colorectal cancer.

Screening both prevents colorectal cancer and reduces mortality.

Colorectal cancer (CRC) is both the nation’s second leading cause of cancer mortality and one of
the most preventable cancers. It is second to lung cancer as a cause of cancer deaths and
shares with lung cancer the unusual distinction of being a largely preventable disease. However,
while a lung cancer begins as a tiny malignancy that grows into a larger tumor, a colorectal cancer
begins as an adenomatous polyp that is not malignant and takes a period of five to 15 years to
transform. This long period of transformation gives physicians an invaluable window of opportunity
to help their patients prevent this cancer.

Two developments in medicine have provided doctors with this opportunity. The first was the
elucidation of the natural history of colorectal cancer, which was documented and published in
the early 1990s. The second was the development of fiber-optic techniques that permitted the
exploration of the body’s cavities. Together, these advances have created the potential for a giant
leap forward in combating colorectal cancer.

The near elimination of new colorectal cancers and a precipitous fall in mortality could be one
of the great medical successes of the early 21st century. If adenomatous polyps could be removed
from the colon before they turn into cancers, the corresponding fall in new cases of colorectal
cancer would be stunning. Mortality from colorectal cancer would be dramatically reduced. The
sizable population that is at increased risk because of a family history of an adenomatous polyp
or colorectal cancer would be protected from that risk. There are few opportunities in medicine
at this time that are as promising as preventing colorectal cancer.

“Doctors who see these multimorbid patients on a regular basis are more likely to remind patients about receiving regular screenings,” Fleming said. “This shows that perhaps some of our outreach efforts should target the folks who are relatively healthy and see no need to visit their physicians regularly.”

The study was funded by the National Cancer Institute. The researchers hope to take the lessons learned from this project and develop a large intervention project that can prevent colon cancer mortality in the U.S.

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