CDC Muddies The Message: There Is No Substitute For Colonoscopy.

Posted on | November 7, 2013 | Comments Off on CDC Muddies The Message: There Is No Substitute For Colonoscopy.

Mike Magee

The CDC and colon cancer in the U.S. are back in the news. This time, it’s the warning that colon screening rates have flattened out. Roughly 1/3 of Americans (23 million people) in the screening age range (50 to 75) have had no screening of any type.(1,2)

For a cancer that’s the number three killer in both men and women, and the number two killer for Americans overall (50,830 deaths predicted in 2013), this is a preventive health missed opportunity of historic proportions.(3,4)

Why? Because almost all colon cancers arise from slow growing polyps which can be reliably detected with a colonoscopy.

First the good news:

Colon cancer has been declining consistently over the past decade. Not coincidentally, colonoscopy screening has been on the incline during this same period.

The bad news:

The messaging from the CDC and other public and private health sources remains muddy on the choice of screening test – 1) colonoscopy which inspects the entire colon, 2) sigmoidoscopy which examines only a portion of the colon, and 3) stool examination for blood which is an indirect and not entirely consistent indicator of cancer of the colon.

In the latest announcement from the CDC, it is clear that support for flexible sigmoidoscopy is waning. Only .7% of the target population had this test compared to 61.7% who had colonoscopy (10.4% had fecal occult blood testing).(3)

Most clinicians would say that’s a trend in the right direction. But Marcus Plescia, MD, MPH, director of the Division of Cancer Prevention and Control at the CDC said, “There are some data to suggest that physicians feel that colonoscopy is really the superior test, and they tend to offer that to their patients more often, and that really is not accurate.”(3)

The truth is: Of the various screenings available, only one is thorough, diagnostic and therapeutic – colonoscopy. The barriers to proper screening for colon cancer involve misperceptions, money, and mindset.(4,5) The misperceptions include the thought that this disease only strikes older men. The reality is, if you are male or female, age 50 or older, you’re well within striking distance. Another misperception – that screening for colon cancer is terribly painful and uncomfortable. The reality – the bowel prep is somewhat annoying but quite manageable at home, and colonoscopy with light sedation is painless.

The expense of the tests can be a roadblock, but insurance companies are coming on board, as they should because colonoscopy to screen for this cancer has been proven to be as cost effective as mammography for breast cancer.(4,5) Compared to the cost of the disease – it’s a bargain. Direct annual medical costs for colon cancer in the U.S. are estimated to be 5,5 to 6.5 billion. (1,2)

But we’ll never reach our full potential in preventive health care if we skate around the truth. In a 2011 DC press conference, CDC Director Dr. Thomas R. Frieden said “I turned 50 a few months ago and I do have a strong family history of colorectal cancer, so I did have a colonoscopy at age 40. It was normal. At age 50, I had another colonoscopy. I had four polyps — two of them large — all of them removed before they became cancerous.” (1)

So he had the appropriate screening. Would sigmoidoscopy or fecal occult blood have revealed his four polyps. Depending on location and bleeding, there’s a good chance the answer is no. But Dr. Frieden in his latest statement said that standard fecal testing is “equivalent to colonoscopy in saving lives when used correctly.”(3)

The CDC needs to catch up with clinicians and the informed public.(6,7)

Here’s the right message: “There is no equivalent substitute for colonoscopy, and it’s universal use could wipe colon cancer off the map.”

For Health Commentary, I’m Mike Magee.

References

1. CDC healthfinder.gov. Colon Cancer Death Rates Continue To Drop, CDC Reports.http://www.cdc.gov/cancer/colorectal/statistics/

2. CDC Statistics on Colon Cancer. http://www.cdc.gov/workplacehealthpromotion/implementation/topics/colorectal-cancer.html

3. Brooks M. Colorectal Cancer Screening Rates Remain Too Low. Medscape. 11/5/13. http://www.medscape.com/viewarticle/813850

4. American Cancer Society. Colorectal Cancer: Facts and Figures. 2009.

5. American Cancer Society. Frequently Asked Questions About Colon Cancer.

6. AAFP. Colon Cancer Screening: What You Should Know. American Academy of Family Physicians.

7. Podolsky DK. Going the distance – the case for true colorectal cancer screening. NEJM. 2000;343:207-208. http://www.nejm.org/doi/full/10.1056/NEJM200011303432214