Why have the tests?
Many news reports highlight the benefits of medical screening for life-threatening diseases. An online post by one doctor suggests that while breast and prostrate screening receive a great deal of coverage, colorectal screening is given a lower profile.
A significant number (1 in 20) of Americans will develop colorectal cancer, and early detection is the key to improving a patient's chances of survival. Failure to diagnose cancer properly is a form of medical malpractice.
The statistics are troubling, with 57,000 deaths in the United States every year. More men under age 75 die because of colorectal cancer than prostate cancer.
Types of tests
There are three types of tests used for screening colorectal cancer.
- Fecal occult blood testing: a test used to check stool samples for hidden (occult) blood. The fecal occult blood test can only detect the presence or absence of blood, the test doesn't indicate potential sources of bleeding, so additional tests generally need to be done.
- Flexible sigmoidoscopy: A test used to look for benign and malignant polyps, as well as early signs of cancer in the descending colon and rectum. With flexible sigmoidoscopy, the physician can see intestinal bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum.
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Colonoscopy: A flexible tube (colonoscope) is inserted into the rectum. The scope has a video camera that allows the doctor to view the inside of the entire colon. The scope can be used to remove abnormal tissue and take tissue samples (biopsies) during a colonoscopy.
When Should You Have a Test?
Doctors are expected to provide guidance to patients, as to the reasons for tests, the types of tests and the frequency.
A doctor should encourage patients to have the appropriate tests on the recommended time interval. Though it's up to patients to schedule these tests, primary care doctors should do their part by encouraging patients to do so.
Some patients may not understand the difference between the various tests, believing them to be duplicative of some other test. Or patients may not realize how many years have passed since they were last tested.
Some patients may be embarrassed and dislike the general thought of having a colonoscope inserted five feet into their lower intestine.
The procedure does produce some discomfort and pain, caused by the inflation of the colon with compressed air, which is necessary to allow the doctor to clearly observe the walls of the colon.
Doctor's role in encouraging and following up with patients
Because of the discomfort - both physical and psychological - that patients have with the colorectal screening procedure, doctors need to be aggressive in recommending the procedure and making sure patients follow through with the tests. This is a challenge that doctors need to understand. It may not be enough to simply suggest patients have the tests.
Doctors can use various methods, including electronic reminders via email and mailing traditional letters, all to prod patients to complete the tests. Doctors should also use their time with patients to explain fully the different types of tests, the purposes of the tests, and why the tests are important.
