Too much uneven, imbalanced reporting of colon cancer screening studies

There’s been a very effective long term marketing campaign on behalf of colonoscopy – which is not the only colon cancer screening option.  In fact, the US Preventive Services Task Force says the options – fecal occult blood testing, sigmoidoscopy, and colonoscopy –  each have risks and benefits that vary – in its screening recommendation for adults ages 50-75.

A common line now is, “The best colon cancer screening option is the one that’s used.”

In that regard, an inexpensive home stool test kit that can be mailed in holds some obvious public health advantages over a several hundred dollar colonoscopy test that requires some less than pleasant bowel prep, an office visit, and a procedure that carries some risk.

Yet, in many media discussions – news stories for today’s discussion – colonoscopy gets the preferential treatment.  Witness the news coverage of two studies in the New England Journal of Medicine this week.

• Time.com:  Colonoscopies Could Prevent 40% of Colorectal Cancers
• CBS.com:  Regular colonoscopies may cut colorectal cancer risk by 40 percent
• Huffington Post: ColonosEditcopy screenings every 10 years could prevent 40% of colorectal cancers
• EverydayHealth.com: Regular Colonoscopies Cut Cancer Risk by 40 Percent
• DailyRx.com: Proven Way to Prevent Colorectal Cancer: Colorectal cancer incidence and deaths may be prevented with regular colonoscopy

None of these stories mentioned another study in the same journal reporting the potential benefits of fecal occult blood stool testing.  Why?  What leads a news organization to peruse a journal and report on one study in it but not another? When you go on the New England Journal of Medicine website, both studies are highlighted right at the top.

Oddly, DailyRx.com, cited in the last bullet above, also posted another story, “Easiest Form of Colorectal Cancer Screening Worked,” regarding the stool test study, but without linking the two stories.

Some news organizations appropriately mentioned both studies.  Examples:

• The Los Angeles Times, which reported:
  • “Because the data sets can’t be compared directly, they cautioned against concluding that colonoscopies are necessarily better than the blood test on the basis of the findings. Studies have found that more patients choose to get blood tests in addition to colonoscopies if they are offered — one reason why the Kaiser system in Northern California, where both co-authors work, uses a “combined approach.” Randomized trials that are already underway may help determine what testing approach prevents the most cancers and deaths, they wrote.”
• HealthDay, which reported:
  • (Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society) said the fecal blood test findings were “of particular importance, because there is the perception among many primary-care clinicians that by offering patients the stool test they are somehow offering them an inferior test.”Patients who now undergo a fecal blood test should expect to see even better protection from cancer, said Dr. Theodore Levin, who wrote an editorial accompanying the two studies in the journal. Levin is an assistant clinical professor of medicine at the University of California, San Francisco.”The old fecal blood test that was done in the Minnesota trial has been improved and enhanced through modern biochemical methods,” said Levin, who also is a research scientist at the Kaiser Permanente Northern California Division of Research. “It’s much more accurate and much more sensitive, so we would expect the benefit to be even greater today with that test.”The blood test may have some potential advantages over colonoscopy, Levin added.”Patients have to undergo an uncomfortable cleansing process prior to a colonoscopy using powerful laxatives, and if they fail to properly cleanse their colon, it could hamper doctors’ ability to detect pre-cancerous polyps. Colonoscopy also can miss smaller lesions.”It may be that a moderately sensitive test that is done more often will have a better chance of detecting colon cancer or preventing death from colon cancer,” Levin said.
• Reuters Health.

At the other end of the spectrum, Minnesota Public Radio, perhaps because the blood stool test study came out of the Minnesota Colon Cancer Control Study, reported only on the fecal occult blood test study, “Stool card proves to be effective cancer screening tool.” Excerpt:

“At the moment I think the best test is the one that gets done,” said (the study’s lead author). “It has a lot of advantages in being inexpensive, readily available and carries no harms. So this might be a very good option for individuals to undergo. And if it’s positive they would get a colonoscopy. But if it’s negative they could get stool cards every year.”

Addendum: a short while later, MPR reporter Lorna Benson responded to my email question, writing:

“The local research angle was a factor, but that wasn’t the main consideration.
 
I thought it was remarkable that the benefit of the fecal occult-blood test screening appears to last so long (a reduction in the risk of death of up to 32 percent, for as long as 30 years in some cases). That is great news for a test that is widely available, relatively inexpensive and not harmful. That’s what made the story newsworthy in my opinion.
 
And of course the study design appeared strong. The follow-up had a large number of mortality events (more than 33,000 deaths). And the original trial it was based on was randomized. Also, the findings were consistent with previous, shorter-term research (which added some confidence to the interpretation).”

Uneven news coverage is just one factor in the uneven public dialogue about colon cancer screening options.  We’ve written about it before:

• The “overselling and overpromising” of colonoscopies

• Colonoscopy, conflicts of interest, and cautionary tales

• Colon cancer screening news coverage all over the map & readers are probably lost

• Memo to Harry Smith & CBS News re: colonoscopy crusading

• Questioning colonoscopy evidence

As we suggest often on this website, we must do a better job in educating the American public about screening tests and the tradeoffs involved in each.

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