When Patients Choose Colon Cancer Screening Method, More Get Tested

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People are more likely to get screened for colon cancer when they are given a choice of what screening method to use, and not simply told to get a colonoscopy, a new study shows.

In the study, people who were recommended to get a colonoscopy were less likely to complete screening than those who were recommended to get a stool test or those who were offered the choice of getting either a stool test or colonoscopy.

"The common practice of universally recommending colonoscopy may reduce adherence to [colorectal cancer] screening," the researchers write in the April 9 issue of the journal Archives of Internal Medicine.

There are currently several screening tests for colon cancer, including fecal occult blood test, which tests for blood in stool, and colonoscopy, which examines the entire colon with an instrument that allows doctors to see inside the colon. Some guidelines say doctors and patients should decide which test to use, while others declare colonoscopy to be the preferred screening test.

It's unclear whether giving people a choice of screening method will improve their adherence to screening, or lead to confusion about which test to use, the researchers said.

In the new study, researchers from the from the University of Washington School of Medicine in Seattle randomly assigned nearly 1,000 people in the San Francisco area to receive a recommendation of colonoscopy, fecal occult blood test (FOBT) or their choice of colonoscopy or FOBT.

After one year, 58 percent of participants had completed a colon cancer screening test. However, 38.2 percent of those told get a colonoscopy got one, whereas 67.2 percent of patients told to get the FOBT test got one, and 68.8 percent of those told to get either screening did.

Whites more often completed colonoscopy screening, and nonwhites more often completed FOBT, the study showed.

African-Americans had the lowest screening completion rate, at 48 percent, while Asians (60.7 percent) and Latinos (62.9 percent) had the highest rates, the researchers said.

The results contradict the idea that giving patients choices may leave them feeling confused, or make them less likely to take action.

"If having too many choices leads to confusion, the study…demonstrates that not having enough choice may lead to inaction, when the only choice is colonoscopy," Dr. Theodore Levin, of Kaiser Permanente Medical Center in Walnut Creek, Calif., wrote in an editorial accompanying the study.

In deciding on a preferred screening test, both the patients' and doctors' perspectives should be included, Levin said. "Providing an option other than colonoscopy for our patients is not overwhelming, but necessary," Levin said.

FOBT is recommended once every year for people ages 50 to 75, while colonoscopy is recommended once every 10 years for those over age 50 who do not have risk factors for the colon cancer, the U.S. Preventive Services Task Force says.

It's unclear whether fecal tests will continue to have higher screening completion rates after more than one year, Levin said.

Pass it on: Recommending colonoscopy as the only method for colon cancer screening may limit the number of people who complete screening for the disease.

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