Prevention

Colorectal cancer screening is mostly underused, but problems with overuse and misuse remain

A new systematic review of the professional literature on enhancing the use and quality of colorectal cancer (CRC) screening finds that although tests are underused, particularly among certain subpopulations in the United States, important problems of overuse and misuse also exist. The review considered the factors that influence the use of CRC screening and which strategies increase the appropriate use of CRC screening and followup.

Among factors associated with higher rates of CRC screening are having regular access to care, having a physician recommendation for screening, having effective patient-provider communication, and participating in regular screenings for other types of cancer. Strategies associated with higher levels of screening include eliminating structural barriers by such interventions as mailing fecal occult blood test (FOBT) cards to patients, providing one-on-one counseling by nonphysician staff to help persons understand CRC screening, and reminding patients when they need screening.

After screening 3,029 titles and abstracts and evaluating 861 full-text articles, the authors included 74 articles addressing factors associated with screening and 22 articles on strategies to increase appropriate screening. The researchers caution that widespread implementation of programs to increase appropriate CRC screening may not be successful unless such programs are both cost-effective from a societal perspective and provide incentives for primary care practices to implement the needed interventions. This study was partly funded by the Agency for Healthcare Research and Quality (Contract No. 290-07-1005).

The most recent recommendation statement on CRC screening by the U.S. Preventive Services Task Force (USPSTF) was issued in 2008. It has recently been reprinted by American Family Physician. See "Screening for colorectal cancer: Recommendation Statement," by the USPSTF in the April 2010 American Family Physician 81(8), pp. 1012-1016. The same issue includes a screening case study with accompanying questions for review. See "Screening for colorectal cancer," by Kenneth W. Lin, M.D., and Ruta Sharangpani, M.D., M.P.H., in the April 2010 American Family Physician 81(8), pp. 1017-1018. Reprints (AHRQ Publication No. 10-R064) are available from the AHRQ Publications Clearinghouse.

For details of the systematic review, see "Systematic review: Enhancing the use and quality of colorectal cancer screening," by Debra J. Holden, Ph.D. Daniel E. Jonas, M.D., M.P.H., Deborah S. Perterfield, M.D., M.P.H., and others in the May 2010 Annals of Internal Medicine 152, pp. 668-676.

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