Choice in colon cancer screening linked to more regular testing

Last Updated: 2015-11-12

By Lisa Rapaport

NEW YORK (Reuters Health) - People may be more likely to get colorectal cancer screenings when doctors let them choose what type of test to have, a U.S. study suggests.

Researchers focused on fecal occult blood testing (FOBT) and colonoscopy examination. They randomized about 1,000 patients into three groups -- FOBT, colonoscopy, or a choice between the two.

Over three years, 42% of participants given a choice between the tests followed through with screening and 38% of people assigned to get colonoscopies did so. Just 14% of the patients assigned to FOBT got the test done each year. In the choice group, there was also a steep drop-off in FOBT after the first year.

"Fecal occult blood testing needs to be repeated every year to have the same protective effect as getting a colonoscopy every 10 years," lead author Dr. Peter Liang, of the University of Washington in Seattle, told Reuters Health. "Allowing people to choose their screening test and using patient navigators to help them get their tests completed will increase the overall adherence to colorectal cancer screening."

To help increase the odds that patients got recommended screenings, members of the research team served as patient navigators during the first year of the study. In this role, they described the screening process to patients, helped schedule tests, explained bowel preparations for testing, and helped arrange transportation home after colonoscopies.

Study participants were identified from the San Francisco Community Health Network, a safety net public health system, and research team members were fluent in English, Spanish, Cantonese, and Mandarin.

People who were homosexual, married, or in serious relationships were more likely to comply with screenings, as were Chinese speakers, the study found.

Patients who were assigned to colonoscopy or chose this option were considered noncompliant if they failed to get the test within the first year of the study.

Participants assigned to FOBT or chose this alternative were counted as noncompliant if they didn't get the test annually during the three-year study, if they got the tests but submitted stool samples incorrectly, or if they failed to follow up with a recommended colonoscopy based on the results.

When researchers looked at whether patients could follow through with FOBT every other year instead of annually, compliance was 40% for the FOBT group, 51% in the colonoscopy group, and 56% for the group given a choice.

U.S. guidelines recommend FOBT every year, but screening programs in Canada and Europe use biannual testing, Liang and colleagues note in an article online November 3 in the American Journal of Gastroenterology.

The study wasn't designed to assess the effectiveness of patient navigators and the withdrawal of this support after the first year might have contributed to lower rates of FOBT compliance, the authors point out.

Even so, the findings highlight the importance of giving patients a say in what type of screening they get, Dr. Samir Gupta, a researcher at the University of California, San Diego, who wasn't involved in the study, told Reuters Health by email.

"Our suspicion is that patients selecting colonoscopy often do so because they value its high sensitivity for polyps and cancer, and don't mind the invasiveness and inconvenience, and that patients selecting stool blood tests often do so because the test is more convenient," Dr. Gupta said.

While previous research has found lower screening rates in some minority groups, the study findings suggest that language barriers can be overcome with patient navigators, Dr. David Lieberman, of Oregon Health and Science University in Portland, told Reuters Health by email.

"Suggesting that the patient perform an 'unpleasant' test when they have no symptoms requires a strong educational component," said Dr. Lieberman, who wasn't involved in the study.

The National Institutes of Health supported this research. The authors reported no disclosures.

SOURCE: http://bit.ly/1OGLxVd

Am J Gastroenterol 2015.