Colon Cancer Screening More Likely When People Are Given A Choice

Enlarge Brian Kersey/AP

Kristen Miller talks over the risks and benefits of colonoscopy with Stephen Hanauer, chief of gastroenterology at the University of Chicago Medical Center.

Brian Kersey/AP

Kristen Miller talks over the risks and benefits of colonoscopy with Stephen Hanauer, chief of gastroenterology at the University of Chicago Medical Center.

One-third of people over age 50 aren't getting screened for colon cancer, despite a big push from the medical establishment. But what if all those people needed was to be given a choice?

People whose doctors let them choose between a colonoscopy or a fecal occult blood test were much more likely to get screened than were people whose doctors told them to go get a colonoscopy.

When given a choice, 69 percent of people get screened for colon cancer within a year, according to a new study. By contrast, just 38 percent of people got a colonoscopy when their doctor recommended that method alone. Compare that to the 67 percent of people who did the fecal blood test when that was the only test recommended.

Clearly, colonoscopy has an image problem.

That's not a huge surprise, since colonoscopy is invasive, inconvenient, and expensive, and a fecal occult blood test, which looks for blood in the stool, is simple, cheap, and just a little bit icky.

This new study suggests that by pushing colonoscopies, doctors may be missing out on a chance to get people screened, especially if patients belong to an ethic or racial minority.

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Given the choice, white people overwhelmingly chose colonoscopy, while African American, Latino, and Asian participants preferred the fecal blood test. Overall, 31 percent of the people given a choice went with the colonoscopy, versus 38 percent for the fecal blood test.

"So there's a clear racial split," says John Inadomi, chief of gastroenterology at the University of Washington and lead author of the study, which was published in the Archives of Internal Medicine. Up till now, he says, most of the research on colon cancer screening has been done in whites.

His team is still sorting through data on the study participants' attitudes about colon cancer screening. The study was conducted with 997 people who got healthcare at federally-funded clinics in San Francisco.

Inadomi says there are clearly big differences in how cultures approach disease prevention. As a result, he says, when it comes to cancer screening, "we can't have one size fits all. We can't say we'll just do colonoscopy for everybody. We have to focus on what the patient wants, not just what we want."

The researchers had expected that being offered choices would make it less likely that people would get screened. The fact that the opposite is true means there's a real opportunity to increase screening, says Theodore Levin, a gastroenterologist at Kaiser Permanente Medical Center in Walnut Creek, Calif. He wrote a commentary in Archives saying that offering a choice may be the key to better cancer screening. "If we're recommending screening that patients don't want to do, they're just going to say no."

Both colonoscopy and fecal occult blood testing are effective ways to screen for colon cancer. Colonoscopy does have some benefits; it needs to be done just once every 10 years, on average, while a fecal blood test should be done each year. But colonoscopy also requires a lengthy preparation process, an invasive examination, and brings with it a small but significant risk of intestinal perforation.

At Kaiser Permanente, patients are routinely offered the fecal blood test. Cards are mailed to patients' home so they can do the test themselves and mail back the results, Levin says.

But in fee-for-service practices, there's more incentive for doctors to refer patients to a gastroenterologist for a colonoscopy. "It's kind of one-stop shopping," Levin says. "They can make the referral to the gastroenterologist, and their work is done."

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