February 19, 2010

The "overselling and overpromising" of colonoscopies

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The Associated Press reports on “A look at underused test in efforts to spur millions needing colon cancer checks.” Excerpts:

The dreaded colonoscopy may get the most attention but a cheap, old-fashioned stool test works, too — and when California health care giant Kaiser Permanente started mailing those tests to patients due for a colon check, its screening rates jumped well above the national average.

Now specialists are looking to Kaiser and the Veterans Affairs health system, another program that stresses stool-tests, for clues to what might encourage more people to get screened for a cancer that can be prevented, not just treated, if only early signs of trouble are spotted in time.

“By overselling and overpromising colonoscopies, we’ve put up barriers for people” to get any type of screening, says Dr. T.R. Levin, Kaiser Permanente’s colorectal cancer screening chief in northern California. …

The $20 stool test — usually handed over by a doctor, performed at home and then mailed to a lab — is considered as effective if properly used once a year. But its use has dropped as colonoscopies took center stage.

Comments (8)

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Gregory D. Pawelski

February 19, 2010 at 8:59 pm

Why has the use of the stool-test dropped? The “sensitivity” is limited to 30%, and a negative result cannot rule out colorectal cancer. If symptoms are present that suggest colorectal cancer, only a test with almost perfect sensitivity would provide adequate assuance that a neoplasm is not present.

InteractMD.com

February 20, 2010 at 1:58 am

Thanks for this. At least it gets us talking about the many different ways of screening for colon cancer. I didn’t really see any evidence in the article that occult blood screening has decreased over time. Also, is it a little unusual that the article doesn’t refer to fecal occult blood testing by its actual name? Just asking…

GrammaD

March 9, 2010 at 1:43 pm

For about the last 20 years there has been no mention of the
fecal occult test. Before that, each time we went to the doctor for a physical we were always handed this little test to do and send in.
I thought it was supposed to be effective.
Does it have something to do with money?. Colonoscopy makes the hospital and doctors a lot more money.

Maryann Napoli, Center for Medical Consumers

March 15, 2010 at 10:03 am

Excellent points, Gary. There’s another missing element to the FOBT story. The RCTs that compared FOBT with usual care did in fact show a 30% reduced risk of colon cancer deaths in those who took the FOBT, but this benefit was canceled by an inexplicable increase in heart-related deaths. Our 2009 article mentions this largely unrecognized finding. See “How good are colonoscopies?”

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