99% of patients think colorectal cancer screening is a good idea—but rates remain low

Colorectal cancer is the second leading cause of cancer-related death in the U.S., but screening rates for the disease continue to be lower than those for both breast and cervical cancers, Courtney C. Moreno, MD, and colleagues at the Emory University School of Medicine reported this month. Colorectal cancer was projected to cause at least 50,000 deaths in the U.S. alone last year, but screening rates top out at 62.4 percent.

“Large randomized clinical trials have shown decreased colorectal cancer-specific mortality with screening,” the authors wrote in Current Problems in Diagnostic Radiology. “It has been estimated that between 236,000 and 550,000 colorectal cancers were prevented by screening during the past three decades in the United States, with an overall decrease in colorectal cancer incidence and a shift from late to early stage cancers being detected.”

In an effort to assess patients’ knowledge of colorectal cancer, as well as their willingness to undergo a score of different screening tests, Moreno et al. surveyed 215 patients, the majority of whom reported having general knowledge about the illness and being aware of survival rates. Those who were most aware of current stats tended to be older than 50, the authors wrote.

Survey respondents were provided with a list of screening options, including colonoscopy, stool-based tests like fecal occult blood tests and DNA tests, and CT colonography. Subtopics were equipped with pro-con lists detailing both advantages and disadvantages of each procedure.

Nearly the whole study population—99 percent—said they believed colorectal cancer screening was a good idea, according to the data. Seventy-three percent of participants said they’d be willing to undergo optical colonoscopy, and 48 percent and 40 percent, respectively, said they would consider stool-based tests and CT colonography (CTC).

“That CTC was the least popular test among our respondents may be in part related to a lack of exposure to or knowledge about CTC,” Moreno and co-authors wrote. “CTC currently is performed infrequently at the campus at which the survey was administered.”

With a push to distribute more information about the screening, the researchers said, should come increased knowledge about the low-level radiation exposure that accompanies CTC. While CTC offers less risk of complication and doesn’t require any sedation or pre-test bowel cleansing prep, a single screening low-dose CTC study at age 60 would leave a patient with a lifelong risk of radiation-related cancer of around 0.05 percent—and 86 percent of survey respondents said they were more likely to undergo screenings if they didn’t involve any radiation.

“Improved patient education about the negligible radiation risk associated with CTC or development of a noninvasive imaging test that did not involve a preprocedural bowel cleansing regimen may increase rates of colorectal cancer screening,” the researchers wrote.

Indeed, 78 percent of respondents said they’d be more willing to be screened for colorectal cancer if the process didn’t involve sedation (60 percent), a preprocedural bowel cleansing regimen (73 percent) or insertion of a tube or device into the rectum (78 percent).

“Ninety-nine percent of respondents reported believing that colorectal cancer screening was a good idea, though many respondents were unaware of basic information about colorectal cancer incidence and prognosis,” Moreno et al. said. “A noninvasive, radiation-free test like MR colonography may increase the likelihood of individuals undergoing colorectal cancer screening.”