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Fact Sheet
Colorectal Cancer Screening among Adults Aged 50 or
Older: Implementation of Fecal Occult Blood Testing in Clinical Practice
Colorectal Cancer Facts
- Colorectal cancer (CRC) is second only to lung cancer as the leading
cause of cancer-related death in the United States. In 2004, it’s
estimated that CRC caused nearly 57, 000 deaths.
- In 2004, an estimated 147,000 new cases of CRC were diagnosed.
Approximately 93 percent of colorectal cancers are diagnosed in men and
women aged 50 years or older.
- Screening tests can find colorectal cancer in its earliest stages when
it can be treated more successfully. Screening also can identify
pre-cancerous polyps so they can be removed before they turn into cancer.
- The fecal occult blood test (FOBT) is one type of CRC screening test.
FOBT can be conducted in the doctor’s office or at home. In the home test,
the person collects several stool samples and places the samples on
special cards, and then sends the cards back to the physician or a lab to
be tested. During the in-office FOBT, the physician collects a single
sample from a patient during a digital rectal exam. The home test is
recommended for CRC screening. The in-office FOBT is not
recommended for CRC screening.
Background
Between 1999 and 2000, the Centers for Disease Control and Prevention
(CDC) collaborated with the National Cancer Institute (NCI) and the Centers
for Medicare & Medicaid Services (CMS) to conduct a national survey of
primary care physicians to examine how colorectal cancer screening and
follow-up are conducted in community practice. The responses were compared
with responses from the public in the 2000 National Health Interview Survey.
The results indicate that physicians may not be following recommended
national guidelines for performing the fecal occult blood test (FOBT) when
they screen patients for colorectal cancer.
The full report is entitled "A National Survey of Primary Care
Physicians' Methods for Screening for Fecal Occult Blood." It is published
in the January 18, 2005 issue of Annals of Internal Medicine. To
learn more about this report, visit
www.annals.org to access the article abstract and a patient summary.
Study Results
- More than 90 percent of physicians said they ordered or performed FOBT.
Although screening guidelines recommend that patients use home tests for
FOBT, 33 percent of physicians said that they use only the in-office test,
which is not recommended for CRC screening.
- Studies suggest that home FOBT saves lives; to date, no studies have
looked at the effectiveness of in-office tests. However, one recent study
clearly showed that in-office tests miss many polyps and cancers that home
tests can detect. Further, national guidelines recommend home FOBT tests
instead of in-office tests.
- National guidelines recommend that patients with positive FOBT results
have an examination of the entire colon and rectum, yet about 30 percent
of physicians recommend that patients first repeat the FOBT.
- Rather than recommending that their patients with positive FOBT
results have total colon exam, almost one-third of physicians recommended
they have sigmoidoscopy, a procedure that examines only part of the colon
and therefore can miss polyps and cancers.
- Results from the survey of the public were consistent with these 2
findings – 1) many people reported having had in-office tests and 2) many
who had an abnormal FOBT reported that they did not have a complete
diagnostic work-up.
Conclusion
Because FOBT is often not performed or followed-up as recommended, fewer
lives may be saved than is potentially possible. Patients who choose FOBT
for CRC screening should use the home test. If they have positive results,
they should have a total colon exam in follow-up.
CDC Action
- Screen for Life: National Colorectal Cancer Action Campaign
educates men and women who are 50 years or older about colorectal cancer
and the importance of having regular cancer screening tests. The campaign
also encourages people to speak with their physicians about the
appropriate screening tests. For more information about Screen for Life
visit
http://www.cdc.gov/cancer/screenforlife.
- For more information on CDC’s national colorectal cancer efforts,
visit
http://www.cdc.gov/cancer/colorctl/.
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