When minority men and women felt that they were being discriminated against by their health care providers, they were less likely to be screened for breast or colorectal cancer. Read the rest of this entry »

Half of Americans over 50 have not been screened for colorectal cancer according to a new survey conducted by the Centers for Disease Control (CDC).

The 2005 National Health Survey interviewed 31,000 adults, including 13,500 who were over 50.  It found that 50 percent of people over the age of 50 had been screened for colorectal cancer, but the other half had not.  While this was an improvement over the 43 percent screening rate in 2000, it was far from desirable according to the researchers who analyzed the information. Read the rest of this entry »

Colonoscopy screening increased by 50 percent in New York City in the past five years, with the biggest increase occurring among minorities.

Much of the improvement is credited to a coalition of doctors, city officials, union workers, and hospital administrators belonging to the New York Citywide Colon Cancer Control Coalition, known as C5.

The Coalition adopted a single colorectal cancer screening recommendation:  all people of average risk over the age of 50 have a colonoscopy every ten years.  People with a family history or other risk factors would be screened more often.

Funding was available to cover the uninsured.

One factor that led to success was using patient navigators to help patients through each step of the process.  The bilingual navigators call patients to remind them of appointments, help them understand preparation for the procedure, and see that they have a ride home after their tests.  They now work in all ten city-run hospitals and another six hospitals in New York.

Overall, patient navigators have facilitated nearly 31,000 colonoscopies in the past five years.  In their first year, the rates of no-shows for colonoscopies dropped from 67 percent to 10 percent and screening rates tripled.

Rates of people over 50 who have had a colonoscopy rose from 2007 to 2003 from:

• 35 percent of African Americans to 64 percent
• 38 percent of Hispanics to 63.3 percent
• 48 percent of whites to 62.2 percent
• 25 percent of Asians to 53.6 percent

The C5 goal is to have 80 percent of New York City residents over the age of 50 screened with a colonoscopy by 2011.

Information about colonoscopy improvement was announced on June 5, 2008 by Dr. Thomas R. Frieden, New York City Health Commissioner.

SOURCE: Dan Hurley, More People Undergoing Colonoscopy, The New York Times, June 6, 2008.

Some polyps and cancers in the intestinal tract bleed at times. Testing for hidden (occult) blood in the stool is an inexpensive and noninvasive way to identify them.

Unfortunately, FOBT or fecal occult blood testing does not find those polyps or cancers that are not bleeding. Depending on the sensitivity of the test, it may miss a fair percentage of cancers and most polyps. And the test may be falsely positive because of other conditions that cause intestinal bleeding, requiring unnecessary colonoscopy follow-up.

The latest 2007 Joint Guidelines for Screening recommend fecal occult blood testing as tests that primarily detect cancer.

However, FOBT has been shown in randomized clinical trials to reduce deaths from colorectal cancer by as much as one-third and is an important part of public health screening strategies.

All positive fecal occult blood tests need to be followed-up with a full colonoscopy to look for polyps or cancer.

There are two approaches to FOBT. The older guaiac-based test (gFOBT) measures one part of the hemoglobin molecule. A newer fecal immunochemical test (FIT) measures a different part. Globin, a protein measured by FIT, is only present in when bleeding occurs in the colon or rectum, eliminating false positives from stomach ulcers and bleeding in the the upper digestive tract or meat eaten before the test.

FOBTs are take-home test kits that are completed by patients. It is important that the tests be done accurately, including restricting certain drugs and foods before some tests and taking enough samples. Accuracy improves with the full number of samples and when the test is done every year.

Guaiac FOBT

Dietary and drug restrictions: When you use the guaiac-based FOBT such as Hemoccult®, it is important to avoid non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, or more than one aspirin a day for seven days before testing. In addition red meat (beef, lamb, and liver) and vitamin C supplements, citrus fruits, and juices should be avoided for three days prior to the test.

Two small samples of three different bowel movements are smeared onto small paper squares. The kit is then returned to the doctor or mailed to a medical laboratory.

FIT

Fecal immunochemical tests (FIT) such as Hemoccult® ICT or InSure® have no drug or dietary restrictions, but it is important to avoid testing during the menstrual period or when there is rectal bleeding or bleeding from the urinary tract.

Samples are collected from bowel movements over two or three consecutive days. Some tests use a stick to collect stool, others use a small brush. None require actually touching the bowel movement.

Digital Rectal Exam

A single test done during a digital rectal exam in a doctor’s office is not sufficient for screening. The United States Preventive Services Task Force says,

Digital Rectal Examination/Office FOBT

There is little evidence to determine the effectiveness of either digital rectal examination or a single office FOBT using a stool sample obtained on DRE. Fewer than 10 percent of colorectal cancers arise within reach of the examining finger, and some of these lesions will already be symptomatic. The sensitivity of a single office FOBT is likely to be substantially lower than that of screening protocols involving multiple test cards: in one study the first test card would have missed 42 percent of cancers detected by screening. Samples collected by DRE may be affected by other limitations, including inadequate amount of stool or trauma from the exam.

Patient Instructions for Some FOBT and FIT screening tests.

Links to instructions are provided for preliminary information for you only. The most current instructions will be included with your test kit. Your doctor may suggest a different brand of test.

Hemoccult ® SENSA

Hemoccult ® ICT

InSure®