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Colon cancer screening news: HealthDay’s story missed opportunity to go beyond news release

digestive system

Expert Panel Reaffirms Need for Colon Cancer Screen Beginning at Age 50

U.S. advisory group says there’s not enough evidence to endorse one screening method over another

Reiterating a recommendation last made in 2008, an influential U.S. panel of health experts is advocating that regular colon cancer screening begin at age 50 and continue until at least age 75.

However, the U.S. Preventive Services Task Force stopped short of saying any one screening method was better than another.

“There are multiple screening options for colorectal cancer that reduce the risk of dying from the disease. We encourage people to choose the best option for them, in consultation with their clinician,” former Task Force member Dr. Douglas Owens said Wednesday in a USPSTF news release.

The panel’s reticence to choose one option over another may be at odds with the preference of many doctors, who often advise colonoscopy as the “gold standard” test.

Dr. Arun Swaminath is one of them.

“There is only one test — colonoscopy — that can both diagnose a polyp/cancer and remove or sample it at the same time,” said Swaminath, who directs the inflammatory bowel disease program at Lenox Hill Hospital in New York City.

“This is key, because a positive stool test plus stool DNA test (such as Cologuard), or a positive imaging test (such as CT colonoscopy) will still require a follow up colonoscopy to confirm and treat the problem,” he explained.

For its part, the American Cancer Society recommends colonoscopy screening once every 10 years, beginning at age 50, or one of a number of other tests at more frequent intervals.

In drafting its updated colon cancer screening guidelines, the USPSTF reviewed data on several screening strategies. Besides colonoscopy, these included flexible sigmoidoscopy (an invasive procedure that penetrates less far than colonoscopy); CT colonography (a scan of the colon); traditional fecal occult blood tests (looking for blood in stool); and the recently approved Cologuard DNA-based stool test.

The panel said there were no comparison studies that suggested that any of the screening methods were any more effective than others. There are varying amounts of proof supporting the effectiveness of each, and each method has its advantages and limitations, the panelists said.

And what about colon cancer screening for the elderly?

In its statement, the panel said that “for some adults ages 76 to 85, the benefits of screening are smaller, and the potential for harm greater. However, some people in this age group may benefit, especially if they have never been screened before and are healthy enough to undergo treatment if cancer is found.”

For this older group, the USPSTF recommends that decisions on screening be made during consultations between the patient and his or her doctor.

All of the recommendations are specific to symptom-free people 50 years of age or older with an average risk colorectal cancer, the panel stressed. People with disorders or medical histories that raise their odds for colon cancer may need more rigorous screening, the USPSTF said.

The updated recommendation was published online June 16 in the Journal of the American Medical Association.

“Evidence convincingly shows screening for colorectal cancer works, but not enough people are taking advantage of this highly effective service,” said Owens, a general internist at the Veterans Affairs Palo Alto Health Care System and a professor at Stanford University.

The USPSTF notes that only one-third of eligible adults in the United States are screened for colon cancer, and more need to take advantage of this effective method of prevention.

Colorectal cancer remains the second leading cause of cancer death in the United States. This year about 134,000 people in the country will be diagnosed with the disease, and about 49,000 will die from it., the panel said

The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive health services.

More information

The U.S. Centers for Disease Control and Prevention has more on colon cancer screening.

SOURCES: Arun Swaminath, M.D., director, inflammatory bowel disease program, Lenox Hill Hospital, New York City; Journal of the American Medical Association and U.S. Preventive Services Task Force, news releases, June 15, 2016

Robert Preidt

Last Updated: Jun 15, 2016

Rating

4 Star

Categories

Expert Panel Reaffirms Need for Colon Cancer Screen Beginning at Age 50

Our Review Summary

ColonoscopeThis story about updated colon cancer screening recommendations offers readers a reasonably faithful summary of the key conclusions of the U.S. Preventive Services Task Force (USPSTF). The key point of the new guidelines is that several methods of screening all work pretty well for people ages 50-to-75, yet many Americans don’t get screened.

Unfortunately, the article doesn’t do much to inform the reader beyond the task force’s news release (available for download here), only stating that “there are varying amounts of proof supporting the effectiveness of each, and each method has its advantages and limitations.”

While it may be cumbersome to explain those benefits and risks in detail, it still would have been useful to go over some of the specifics, such as risks and costs, so that people get a basic idea of some of the complex trade-offs at hand.

 

Why This Matters

While cancer screening doesn’t always produce clear benefits, the USPSTF concludes colon cancer screening does offer substantial benefits for most people between the ages of 50 and 75. Given the high rates of colon cancer in the U.S., this is important news to convey to the public.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The costs of screening vary dramatically, not only by test but also by the terms of a person’s health care insurance coverage. Insurance may completely cover the cost of screening, but depending on their insurance, people who get follow-up tests to check a suspicious screening test result may get hit with thousands of dollars in medical bills. Especially since the task force highlighted the importance of individuals deciding on the right type of colon cancer screening for themselves, which certainly includes their insurance coverage, the story should have mentioned costs. Also, though not directly addressed in these guidelines, it is worth noting that colon cancer screening is covered under the Affordable Care Act, but that workup of an abnormal screening test may not be.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not quantify the benefits of the different colon cancer screening methods. While we’re sympathetic to the challenges of doing so on deadline–especially when the task force went out of its way to not cover this ground–this nonetheless should have been included. The effectiveness of different screening tests differ, as well as the quality of that evidence, and readers would welcome knowing these differences in quantified terms.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story should have mentioned some of the potential harms of screening, ranging from anxiety over a worrisome result to bleeding, colon perforation, sedation-related events and other problems. Also, since the story specifically included comments lauding colonoscopy, it should have also mentioned that colonoscopy accounts for most of the serious harms caused by colon cancer screening.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The USPSTF recommendation is the result of not only a structured review of available studies on colon cancer screening, but also new analyses of the data, in order to seek a deeper understanding of the pros and cons of various screening strategies. Though the story could have done a lot more to explain that, enough of the basics are included to warrant a Satisfactory here.

The story ideally would have explained what sets this recommendation apart from other reports that come from various groups of experts giving their opinions. Also, it should have noted that the USPSTF gave the recommendation for screening between ages 50 and 75 an “A” grade (the highest level of confidence), while screening of those over 75 (based on individual considerations) received only a “C” grade (moderate certainty).

Does the story commit disease-mongering?

Satisfactory

If anything, this story more restrained than the USPSTF recommendation, which strongly urges colon cancer screening, saying that the biggest problem is that nearly one-third of eligible adults have never been screened.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes comments from a physician who is not on the USPSTF and who expresses a different viewpoint. We won’t mark down the story for not discussing conflicts of interest because the USPSTF is a voluntary, publicly-funded body and none of the members reported any conflicts in their disclosure forms.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story lists all the screening techniques the USPSTF looked at. It notes that the report intentionally did not rank the techniques and includes a dissenting opinion from a physician who was not part of the task force.

It was also worth mentioning that an average risk person who is informed about the screening may chose not to be screened as a reasonable choice, but only as part of a shared decision making process with her/his doctor.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It is clear that all of the screening tests mentioned in the story are generally available.

Does the story establish the true novelty of the approach?

Satisfactory

The story points out that this report and recommendation is an update of one the USPSTF issued in 2008. It is clear that all of the screening tests mentioned in the story have been available for years, except for a DNA-based stool test that the story notes was approved recently.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story includes comments from an independent physician, which is enough to squeak by as Satisfactory on this rating. However, it should be noted that all of the comments from the USPSTF came from a news release. Although the story clearly attributes the source of the USPSTF comments, which is good, ideally there would also have been at least some original commentary directly from task force members, providing unique insights not found in the news release.

Total Score: 7 of 10 Satisfactory

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