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Rates of colon cancer screening remain low among patients seen in primary care practices

All men and women aged 50 years and older should be screened for colon cancer, which is the third most common form of cancer in the United States. Yet only about half of primary care patients are screened either with fecal occult blood testing (FOBT, to detect blood in stool) or colon examination by sigmoidoscopy/colonoscopy, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS07373). Researchers from the MEDTEP Research Center at the University of California, San Francisco, retrospectively reviewed the medical records from three primary care practices in an academic medical center to identify colon cancer screening among patients of all races aged 50 to 74 who had at least one visit between mid-1995 and mid-1997.

They defined screening most liberally as FOBT in the past 1 to 2 years, sigmoidoscopy in the previous 5 to 10 years, or colonoscopy in the past 10 years. Of the 6,039 patients who made medical visits during the study period, only 53 percent had undergone some type of colon cancer screening. About 47 percent had received FOBT in the past 2 years, about one-quarter had undergone sigmoidoscopy in either the past 5 or 10 years, and only 3 percent had undergone colonoscopy. Only 14 percent of patients had received FOBT in the past year as well as sigmoidoscopy in the past 5 years (as recommended in most current guidelines).

Women were less likely to be screened than men, and patients who were younger (aged 50 to 54), had been seen less frequently, were uninsured, or did not have managed care insurance were less likely to be screened than others. Patients who had been diagnosed with a gastrointestinal illness or had a family history of colon cancer were more likely to have been screened. However, only a third of high-risk patients with a family history of the disease had undergone any cancer screening. Patients of nurse practitioners were 22 percent less likely to receive FOBT than patients seen by physicians, and patients of residents were 21 percent less likely than those of faculty to have sigmoidoscopy.

More details are in "Colon cancer screening in the ambulatory setting," by Judith M. Walsh, M.D., M.P.H., Samuel F. Posner, Ph.D., and Eliseo J. Perez-Stable, M.D., in Preventive Medicine 35, pp. 209-218, 2002.

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