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Studies Examine Colorectal Cancer Screening Rates

ening method that involves taking X-rays of the colon and rectum.

A total of 5,125,938 screening tests for colorectal cancer were performed on 2,402,657 patients between 1998 and 2003—an average of 2.1 procedures per patient. The number of tests increased from 432,778 in 1998 to 1,179,764 in 2003. Also in that time period, the proportion of FOBT tests increased from 81.7 percent to 90.4 percent; screening colonoscopy declined from 5.7 percent to 4.7 percent; flexible sigmoidoscopy declined from 8.3 percent to 3.6 percent; and double contrast barium enema declined from 4.1 percent to 1.3 percent.

Although the number of screening colonoscopies performed during that time increased from 24,955 to 55,199, the percentage of colonoscopies used for screening rather than diagnostic or other purposes increased only slightly, from 34.3 percent to 38.4 percent. “Although screening colonoscopy more than doubled in frequency, it still constitutes a small proportion of colorectal cancer screening,” the authors write. “Overall, there was no significant difference in the likelihood of undergoing screening colonoscopy between 1998 and 2003.”

FOBT has been criticized for its lack of ability to correctly identify those with and without colorectal cancer, they continue. “Apart from the advantages of colonoscopy … the effectiveness of an FOBT-based screening program in clinical settings (as opposed to clinical trials) is unclear. The predominant use of FOBT for colorectal cancer screening in the VA, while strikingly different from other health care systems in the United States, may not necessarily lead to worse outcomes in terms of colorectal cancer–related incidence and mortality. It does, however, call for closer examination of the process and outcomes of this practice in VA settings.”

In the second study, Shahnaz Sultan, M.D., then at Duke University Medical Center and Durham Veterans Affairs Medical Center, North Carolina, and now at U
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