Colorectal cancer screening should start at 45, new research shows

Infographic on CRC. 

Screening for colorectal cancer (CRC) should begin at 45 years of age to match rising mortality rates in young adults, research presented today at the 25th UEG Week Barcelona reveals.

Scientists in France analysed 6,027 colonoscopies and found a 400% increase in the detection of neoplasia (the new, uncontrolled growth of abnormal tissue) in patients aged between 45-49 in comparison to patients aged 40-44. The neoplasia detection rate was also 8% higher in people aged between 45-49 than it was between 50-54, leading to calls for CRC screening programmes to begin at 45 years of age.
The mean number of polyps (growths on the inner lining of the colon that can turn cancerous if left untreated) and the adenoma detection rate (proportion of individuals undergoing a colonoscopy who have one or more adenomas detected) also increased by 95.8% and 95.4% respectively between the 40-44 and 45-49 age groups. This was far more substantial than the increase between the 45-49 and 50-54 age groups, which was 19.1% and 11.5% respectively.
Lead researcher, Dr David Karsenti, who will present the findings for the first time today at UEG Week, explains; "These findings demonstrate that it is at 45 years old that a remarkable increase in the colorectal lesions frequency is shown, especially in the detection rate of early neoplasia. Even when patients with a familial and personal history of polyps or cancer are excluded from the findings, there is still a noticeable increase in detection rates in patients from the age of 45."

The mean number of polyps, adenoma detection rate and neoplasia detection rate by age. Credit: UEG

CRC is the second most common cause of cancer-related death in Europe, killing 215,000 Europeans every year, with research recently revealing that three in ten CRC diagnoses are now among people younger than 55. There is strong evidence to demonstrate that screening for CRC reduces incidence and mortality rates, yet there are vast inequalities in CRC screening across Europe with both organised and opportunistic schemes, different types of tests and varying participation and detection rates. Despite the dramatic rise of CRC in young adults, the vast majority of screening programmes throughout Europe commence between the ages of 50 and 55, with some not beginning until the age of 60.
Dr Karsenti adds "Regardless of the type of screening that is in place, the results of our research strongly indicate that screening for colorectal cancer should begin at the age of 45. This will this help us to increase the early detection of colorectal cancer in young adults and also enable the identification and safe removal of polyps that may become cancerous at a later date."

The neoplasia detection rate by age. Credit: UEG

More information: 1. Karsenti, D. et al (2017), Adenoma detection rate according to age: colonoscopy screening should start at 45 years old, Presented at the 25th UEG Week Barcelona, October 30, 2017.
2. Epidemiology of colorectal cancer: international comparison, 4th European Colorectal Cancer Days 2015. Available at: www.crcprevention.eu/index.php … -cancer-epidemiology
3. Dramatic rise in colorectal cancer in younger adults (2017), Medscape. Available at: www.medscape.com/viewarticle/876409


Provided by United European Gastroenterology

Task Force presents new ranking of colorectal cancer screening tests

In its latest recommendations, the US Multi-Society Task Force (MSTF) on Colorectal Cancer (CRC) Screening confirms that people at average risk should be screened beginning at age 50, and recommends colonoscopy and fecal immunochemical testing (FIT) as the "first tier" screening tests for this group. Screening continues to be a first line of defense against CRC, as it can detect pre-cancerous growths as well as cancer, which is highly treatable if caught early.

28 jun 2017--Overall, the incidence of colorectal cancer (CRC) in people age 50 and older is declining. However, the task force noted a rising incidence of CRC in younger Americans, for reasons that are unclear. While the relative incidence in younger people remains low, the increasing trend of young onset CRC is nevertheless a "major public health concern." In addition, the task force suggests beginning screening earlier in the African-American population, at age 45.
"Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer" was published jointly in three gastroenterology journals, Gastroenterology, The American Journal of Gastroenterology and GIE: Gastrointestinal Endoscopy (published online June 6).
Recommendations for screening are re-evaluated periodically as new evidence emerges and as shifts occur in healthcare delivery and access. The task force, made up of representatives from the American Society for Gastrointestinal Endoscopy, American College of Gastroenterology and American Gastroenterological Association, evaluated seven different types of screening tests based on effectiveness at detecting cancer and pre-cancerous polyps.
Experts know that offering screening tests systematically to people without any symptoms is the best way to prevent colorectal cancer and to detect it at an earlier, more treatable stage. However, the large number of options available for screening, and the wide variation in effectiveness, acceptability to patients and cost, suggests that guidance is needed to facilitate discussions between physicians and patients and make the process of offering screening both feasible for physicians and easily understood and accepted by patients.
"We believe these recommendations make the presentation of screening options in the office easier for providers and patients, maximizing both effectiveness and adherence. The document also addresses important issues for organized screening programs that are sometimes used in large health plans," said lead author Douglas K. Rex, MD, FASGE, AGAF, MACG. "These recommendations are informed both by available scientific evidence, as well as practical considerations and cost data."
The document includes sections on screening tests, targets, cost and quality; practical considerations; family history as a risk factor; and age considerations. Each screening test is explained, along with advantages and disadvantages. Strength of evidence is noted in the document for various recommendations.

Screening Tests

The task force ranked tests into three "tiers" according to the strength of the recommendation for average-risk people. The task force also incorporated practical considerations, such as test availability, cost effectiveness, current usage patterns, obstacles to implementation, and the likelihood that patients will repeat the test when they should.
For any test other than colonoscopy, patients need to understand that if they have a positive result, they will need to undergo a colonoscopy to follow up on those results.
Tier 1— the cornerstone tests—are colonoscopy every 10 years or annual FIT. Colonoscopy is highly sensitive for cancer and all classes of precancerous lesions, and it is the only test that allows a patient to be diagnosed and treated in a single session. FIT is less sensitive and must be repeated every year, but it is non-invasive, lower-cost, and performs very well in preventing cancer and cancer deaths when repeated annually. For these reasons, FIT is an attractive option in large health plans with organized screening programs, which also have systems in place to ensure annual testing.

Tier 2 options include:

• CT colonography every five years
• FIT-fecal DNA every three years
• Flexible sigmoidoscopy every five to 10 years

Tier 3 options include:

• Capsule colonoscopy every five years

Available tests not recommended:

• Septin9 (a blood-based test)

Highlights of the screening test recommendations include:

• Colonoscopy should be performed every 10 years or a FIT administered every year as first-tier options for screening average-risk persons for colorectal neoplasia.

Physicians performing screening colonoscopy should measure quality, including the adenoma detection rate.
Physicians performing FIT need to monitor quality. The recommended quality measurements for FIT programs are detailed in a prior publication.1
Patients who refuse colonoscopy or FIT should have CT colonography every 5 years, FIT-fecal DNA every three years, or flexible sigmoidoscopy every five to 10 years .
Capsule colonoscopy (if available) is an appropriate screening test when patients decline colonoscopy, FIT, FIT-fecal DNA, CT colonography, and flexible sigmoidoscopy.
Septin9 is not recommended for CRC screening.

Family History

A family history of CRC in a first-degree relative (parent, sibling or child) increases a person's risk of developing this type of cancer, regardless of the age when the relative is diagnosed.
Highlights of recommendations pertaining to family history include:
People with a family history of CRC in a first-degree relative diagnosed before age 60 should undergo colonoscopy every five years, beginning at age 40 or 10 years before the age at which their relative was diagnosed, whichever comes first. The same is true for those who have a first-degree relative with a documented advanced adenoma or documented advanced serrated lesions.
People with one first-degree relative diagnosed at age 60 or older are advised to begin screening at age 40.

CRC increasingly is found in younger people

The incidence of CRC is rising in people under age 50. The reasons for this trend are not known at this time. Although the rate of CRC in this age group is still low, the increase is a "major public health concern," according to the authors.
Aggressive evaluation of patients with symptoms is recommended as an important first step, particularly for symptoms involving bleeding, which may include blood in the stool, black or tarry stool with a negative upper endoscopy, or iron deficiency anemia. If a test other than colonoscopy is used to evaluate bleeding symptoms, a diagnosis should be made, and the patient should be treated and followed until resolution of the problem.
Patients who have only non-bleeding symptoms, such as abnormal bowel habits, change in bowel habits or appearance, or abdominal pain, but who have no evidence of bleeding, are no more likely to have cancer than asymptomatic persons of similar age.

Rationale for screening earlier in African-American population

In the African-American population, there is a lower screening rate for CRC, higher incidence rates of cancer, and worse survival statistics compared with other races. The task force outlined a scientific rationale for starting screening earlier based on higher cancer incidence, as well as the younger mean age of colorectal cancer onset in this population even as they acknowledge that there are few data to show that screening before age 50 improves outcomes in this group.
For the first time, the new MSTF document suggests beginning screening at age 45 for African-American patients, though the task force noted the need for additional study of the yield of CRC screening in persons under age 50, and particularly in this population.
The task force added that recommendations to screen earlier in this group "have served an important role in stimulating discussion of and research on CRC in African Americans, increasing awareness in physicians of an important public health problem and racial disparity in health outcomes in the United States, and increasing awareness of CRC in African Americans." The group added that "provider recommendation is key," and that patient navigation services can improve compliance with colonoscopy screening.

Conclusion

In summary, the task force recommends beginning CRC screening at age 50 for average-risk patients, and considers colonoscopy and FIT to be the cornerstones of screening for these patients regardless of the healthcare setting. The authors stressed that optimal results in CRC screening depend on good technical performance and reporting of tests and ensuring that patients undergo appropriate follow-up after testing.
"Screening often originates in the doctor's office, and in that setting, colonoscopy is particularly attractive, because it needs to be performed so infrequently. However, if patients decline colonoscopy, they should be offered FIT, and if they decline FIT, a second-tier test should be offered," said Dr. Rex.
"In the doctor's office, it's also reasonable to present the pros and cons of both colonoscopy every 10 years and annual FIT to patients, so they can choose between the two tests. This approach provides a framework for screening that is simple and accommodates almost every healthcare setting," Dr. Rex continued. "These recommendations constitute a practical approach toward the ultimate goal of maximizing screening rates, while using well accepted, effective and cost-effective tests."

More information: 1. Robertson DJ, Lee JK, Boland CR, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the U.S. Multisociety Task Force on colorectal cancer. Gastrointest Endosc 2016: 85:2-21


Provided by American Society for Gastrointestinal Endoscopy

USPSTF recommends CRC screening for 50- to 75-year-olds

08 oct 2015—The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer (CRC) screening starting at age 50 years and continuing through age 75 years. These findings form the basis of a draft recommendation statement, published Oct. 5 by the USPSTF.
Researchers from the USPSTF conducted a systematic review of the evidence relating to screening for CRC. They examined the effectiveness or comparative effectiveness of screening tests on CRC incidence and mortality; diagnostic accuracy of screening tests; and harms of screening.
The USPSTF recommends CRC screening for adults aged 50 to 75 years; variation was seen in the risks and benefits of different screening methods (grade A recommendation). For adults aged 76 to 85 years, the decision to screen for CRC should be an individual one based on patient health and prior screening history (grade C recommendation). The draft recommendation statement is available for public comment from Oct. 6 through Nov. 2.
"Colorectal cancer screening is a very effective, but underused, health promotion strategy in the United States," USPSTF member, Douglas K. Owens, M.D., said in a statement. "The evidence is clear that adults ages 50 to 75 years will substantially benefit from getting screened, but about one-third of these people have never done so."

More information: Evidence Review
Draft Recommendation Statement
Comment on Recommendations

Screening for Colorectal Cancer Saves Lives

11 dec 2008 -- The use of fecal occult blood testing to screen for colorectal cancer reduces the number of deaths caused by the disease, according to an Italian study.

Researchers at the Institute for the Study and Prevention of Cancer in Florence examined colon cancer incidence and deaths in two regions of Italy that introduced colorectal screening at two different times. The Empolese-Mugello district introduced screening in the early 1980s and the rest of the Florence and Prato provinces began screening in early 2000.

Between 1985 and 2006, the Empolese-Mugello district had a larger decline (13 percent) in colon cancer deaths than the rest of the Florence and Prato provinces. The Empolese-Mugello district had a 2.7 percent annual decline in colon cancer deaths during that time, compared with a 1.3 percent annual decline in the rest of the Florence and Prato provinces.

"Our results support the hypothesis that the observed difference in colorectal cancer mortality is due to earlier exposure to fecal occult blood test screening," the researchers wrote.

The study was published in the Dec. 9 issue of the Journal of the National Cancer Institute.

Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force

Ann G. Zauber
12 oct 2008--Background: The U.S. Preventive Services Task Force requested a decision analysis to inform their update of the recommendations for colorectal cancer screening.
Objective: To assess life-years gained and colonoscopy requirements for colorectal cancer screening strategies and identify a set of recommendable screening strategies.
Design: Decision analysis using 2 colorectal cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network.
Data Sources: Derived from the literature.
Target Population: U.S. average-risk 40-year-old population.
Perspective: Societal.
Time Horizon: Lifetime.
Interventions: Fecal occult blood tests (FOBTs), flexible sigmoidoscopy, or colonoscopy screening beginning at age 40, 50, or 60 years and stopping at age 75 or 85 years, with screening intervals of 1, 2, or 3 years for FOBT and 5, 10, or 20 years for sigmoidoscopy and colonoscopy.
Outcome Measures: Number of life-years gained compared with no screening and number of screening tests required.
Results of Base-Case Analysis: Beginning screening at age 50 years was consistently better than at age 60. Decreasing the stop age from 85 to 75 years decreased life-years gained by 1% to 4%, whereas colonoscopy use decreased by 4% to 15%. Assuming equally high adherence, 4 strategies provided similar life-years gained: colonoscopy every 10 years, annual Hemoccult SENSA (Beckman Coulter, Fullerton, California) testing or fecal immunochemical testing, and sigmoidoscopy every 5 years with midinterval Hemoccult SENSA. Hemoccult II and flexible sigmoidoscopy every 5 years alone were less effective.
Results of Sensitivity Analysis: The results were most sensitive to beginning screening at age 40 years.
Limitations: The stopping age for screening was based only on chronological age.
Conclusions: The findings support colorectal cancer screening with the following: colonoscopy every 10 years, annual screening with a sensitive FOBT, or flexible sigmoidoscopy every 5 years with a midinterval sensitive FOBT from ages 50 to 75 years.

Study confirms colorectal cancer screening should start at age 50

Colonoscopy best prevention method for colorectal cancer

Bethesda, MD 03 sept 2008 – Colorectal adenomas, the precursor polyps in virtually all colorectal cancers, occur infrequently in younger adults, but the rate sharply increases after age 50. Additionally, African Americans have a higher rate of proximal, or right-sided, polyps, and may have a worse prognosis for survival if the polyps become cancerous. Therefore, the results of this study further emphasize the importance of colonoscopies, which view the entire colon, for the prevention of colorectal cancer beginning at age 50. The results of this study, which represents the largest investigation, by several-fold, of this kind, were published in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute.

"While colorectal polyps are rare in adults aged 30 to 50, our study reveals an increase in polyp prevalence with age and a dramatic increase in colorectal adenoma incidence occurring in adults over the age of 50," said Francis M. Giardiello, MD, of The John Hopkins University and lead author of the study. "Understanding the natural occurrence of colorectal polyps, especially in younger adults, is important to the development of colorectal cancer prevention strategies."

Findings

Researchers found the prevalence of colorectal polyps in younger adults increased from 1.72 percent to 3.59 percent from age 30 to 50. This rate sharply increased after age 50 with the prevalence of polyps ranging from 10.1 to 12.06 percent in the sixth and ninth decade, respectively. The study results quantified the number of adenomas typically found in people under the age of 50. It is important to note that those with two or more adenomas under 50 years of age represent unusual individuals who might merit closer colonoscopic surveillance for subsequent adenoma development.

In younger adults, adenomas were more prevalent in Caucasians compared to African Americans; however, in older adults, the reverse was true. Regardless of age, adenomas were more prevalent in men than women.

In the general population, left-sided adenomas are most common, but among older adults (age 50+), who have more adenomas, there is a relatively greater prevalence of right-sided adenomas. African Americans in both age groups had predominately right-sided polyps.

Implications for Colorectal Cancer Screening

The use of sigmoidoscopy as a screening test for colorectal cancer does not allow gastroenterologists to view the right-side of the colon to screen for polyps, only the rectum and the lower end of the colon. If a polyp or abnormality is found, patients may require a regular colonoscopy for further evaluation. Right-sided adenomas cannot be viewed using a sigmoidoscopy.

Colonoscopy, which provides the most comprehensive view of the colon, is the definitive test for colorectal cancer screening. Colonoscopies allow gastroenterologists to view the entire colon and rectum for polyps or cancer and during the same exam remove pre-cancerous polyps. It is the test most gastroenterologists recommend as the single best screening exam for colorectal cancer. It is the only method that combines both screening and prevention (by removal of pre-cancerous polyps).

Study Design

The study evaluated the large intestine of 3,558 autopsy subjects, aged 20-89, that had colorectal cancer undetected or unsuspected during life. Subjects were categorized by sex, race and age in 10 year groups. Location and number of colorectal adenomas detected was measured by using epidemiologic autopsy in individuals; results were standardized to the general population. The study's researchers evaluated the large intestine of 1,001 individuals undergoing necropsy between the ages of 20 and 49 for the presence of adenomas.

Virtual Colonoscopy May Be Used First in Screening for Colorectal Cancer

October 10, 2007 — Computed tomographic colonography (CTC), also known as virtual colonoscopy, produced similar rates of detection for advanced neoplasia vs optical colonoscopy (OC), researchers report. The results of this large comparative study, which appears in the October 4 issue of the New England Journal of Medicine, suggest that primary CTC along with selective OC should be considered as a preferred screening strategy.
"Virtual colonoscopy is an effective method of colorectal screening, with less risk of complications as compared to optical colonoscopy," said lead author David H. Kim, MD, from the Department of Radiology at the University of Wisconsin, Madison. Seven colonic perforations were observed in the optical colonoscopy group, and 4 patients required surgery to repair the injury. However, there were no perforations or any other serious procedure-related complications observed in the CTC group. "CTC is less invasive and some patients prefer to go this route," he told Medscape Oncology in an interview. "The screening population is a very heterogenous group and some patients prefer one method over another."
"A common question from the referring physicians is why would patients want to have a virtual colonoscopy if they are going to eventually need both," said Dr. Kim. "It seems to be a common misconception."
In reality, most patients undergoing a primary screening CTC would not need to have an OC. "About 87% of test results are negative," he said, "And only 13% are positive, of which only 8% have undergone therapeutic colonoscopy. Thus, only about 8 out of 100 patients would need to undergo both tests."
However, despite the fact that colorectal cancer can be prevented in many cases by removing advanced adenomas before they progress to cancer, screening compliance remains less than optimal. "There are probably 40 million people over the age of 50 that are not screened," said Dr. Kim. "Both methods are going to be needed in order to make a positive impact."
Dr. Kim and colleagues compared the diagnostic yield from parallel studies of CTC and OC by comparing primary CTC screening in 3120 consecutive patients with primary OC screening in 3163 consecutive patients. The main outcome measures were to compare the rates of detection for advanced adenomas and adenocarcinomas, as well as the overall rates for polypectomy.
At the University of Wisconsin, there are 2 clinically established programs for colorectal cancer screening. "We have screening based on CTC which operates independent of screening by traditional optical colonoscopy," Dr. Kim explained. "That's what allowed this study to be done. We have the results of 2 programs that are operating and drawing from the same geographical group of patients, the same referring physicians, and a choice of procedure that was made by the patient in consultation with their physician."
Patients were referred for polypectomy if CTC detected a polyp that was at least 6 mm in size. Those with smaller polyps, in the range of 6 to 9 mm, were also offered the option of continued CTC surveillance as an alternative to polypectomy. Patients who underwent a primary OC had nearly all detected polyps removed during the procedure, regardless of the size of the polyps, in accordance with established guidelines.
A total of 123 advanced neoplasms were detected during CTC, including 14 invasive carcinomas. During OC, 121 advanced neoplasms were detected, with 4 invasive carcinomas. Among patients who received CTC screening, 246 (7.9%) were referred for colonoscopy.
Confirmation of advanced neoplasia was similar between the 2 groups: 100 (3.2%) patients who received primary CTC, and 107 (3.4%) who received primary OC. These numbers did not include 158 individuals with 193 unresected small polyps that were detected on CTC who had chosen to undergo surveillance.
"There is more data than people realize suggesting that surveillance can be done safely," explained Dr. Kim. "If our patients have polyps that are 6 to 9 millimeters, they are given an option — they can have them removed or we offer them imaging surveillance as part of an IRB [Institutional Review Board]-approved research protocol."
The number of polypectomies performed differed significantly between the 2 groups, although the overall outcomes were similar. In the CTC group, a total of 561 polyps were removed vs 2434 among patients who underwent OC.
Currently, screening colonoscopy removes all detected polyps, regardless of the size of the polyps, but with a screening CTC, the patient needs to have a second procedure if a sizeable polyp or multiple polyps are detected, Dr. Kim emphasizes. "If we are able to filter out the patients with high-risk polyps for referral to colonoscopy, we can save on cost, complications, and resource utilization," he continues. "Selection polypectomy strategies at CTC allow removal of high-risk polyps and surveillance for low-risk subgroups. In our study, these strategies allow similar detection yields of advanced neoplasias yet with a marked savings in terms of polypectomies."
Limited follow-up data are currently available for the patients opting for surveillance screening. The majority of patients are awaiting interval CTC examination, and among those with 1 or 2 polyps of 6 to 9 mm, 54 have returned for follow-up CTC with findings of 70 small polyps. Within this cohort, the majority of polyps (96%) were found to have either remained stable or have decreased in size. Only 3 polyps increased in size and were removed, although they did not reach the 10-mm threshold, and on histologic examination, none displayed a high-grade dysplasia.
At the present time, Medicare does not cover CTC for screening purposes, only for diagnostics. However, 1 advantage to not having national reimbursement is that individuals doing research with CTC have been able to really maintain quality, Dr. Kim pointed out.
"As this rolls out, I think that there will be guidelines that make sure physicians are adequately trained, and quality metrics for programs are in place, so that each facility will be held to a certain standard," he said.
Three of the study authors have disclosed various financial relationships with C.B. Fleet, Viatronix, Medicsight, Philips Medical Systems, and AstraZeneca. The remaining study authors have disclosed no relevant financial relationships.
N Engl J Med. 2007;357:1403-1412.

Simple, personalized interventions improve colorectal cancer screening rates

Different types of personalized interventions can improve colorectal cancer (CRC) screening rates in primary care practices, according to a new study. Writing in the November 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, Dr. Ronald Myers from Thomas Jefferson University in Philadelphia and co-authors found in primary care practices that, compared to no intervention at all, a personalized behavioral intervention service offered to patients who are not up to date with screening guidelines - from a simple targeted mailing of CRC information and screening supplies to contacts that address psychosocial barriers to screening use - significantly improved CRC screening rates.
Colorectal cancer is the third most common cancer and the third leading cause of cancer-related deaths in both men and women in the United States. Since most patients do not become symptomatic until the disease has become advanced, early screening is critical to saving lives. Current guidelines for men age 50 and older differ on the frequency of required screenings, but general recommendations include fecal testing for blood every one to two years, flexible sigmoidoscopy or barium enema every five years, and colonoscopy every ten years. However, recent studies show that only 42 percent of Americans had received fecal testing or endoscopy in the previous five years.
Dr. Myers and his co-investigators conducted a randomized controlled clinical trial to evaluate the efficacy of standard and tailored educational interventions targeting at-risk patients in primary practice settings. The investigators randomly assigned 1,546 at-risk patients to either no intervention/control (n=387), standard intervention (SI) with mailing education and screening supplies (n=387), tailored intervention (TI) with mailing personalized education and screening supplies (n=386), or tailored intervention plus one-year phone (TIP) follow-up (n=386).
Dr. Myers and his co-authors found that Two years after enrollment, patient screening rates were significantly higher in each intervention group compared to the control group. Only 33 percent of the controls that received no intervention received CRC screening compared to 46 percent in the SI, 44 percent in the TI, and 48 percent in the TIP groups.
Analysis of the demographic characteristics of each group showed that advanced age and education levels, as well as prior cancer screening, were predictive of higher rates of screening, as were the beliefs that screening works and is supported by physicians. Being close to deciding in favor of screening was also a positive predictor. Anxiety about the tests predicted avoidance of CRC screening.
This study confirms that CRC screening can be increased significantly in primary care practices. In addition, the study shows that there is a significant benefit associated with using simple interventions to raise CRC screening rates. Findings also indicate that screening promotion services delivered by an ancillary service provider could dramatically increase CRC screening use in primary care practices. “These findings provide support for the use of simple, personalized interventions in primary care practice settings to increase CRC screening use among adult patients who are not up to date with CRC screening guidelines,” conclude Dr. Myers and his co-authors.
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Article: “A Randomized Controlled Trial of the Impact of Targeted and Tailored Interventions on Colorectal Cancer Screening,” Ronald E. Myers, Randa Sifri, Terry Hyslop, Michael Rosenthal, Sally W. Vernon, James Cocroft, Thomas Wolf, Jocelyn Andrel, Richard Wender, CANCER; Published Online: September 24, 2007 (DOI: 10.1002/cncr.23022); Print Issue Date: November 1, 2007.