Colorectal cancer screening: Make the recommendation

AMA Leader Commentary. By J. Edward Hill, MD, and John R. Seffrin, PhD, April 17, 2006.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from the president of the American Medical Association, J. Edward Hill, MD; and the chief executive officer of the American Cancer Society, John R. Seffrin, PhD.

Words are powerful medicine when it comes to saving lives from colorectal cancer. A physician recommendation might be the most important factor in whether a patient is screened.

In a recent survey of women ages 50 and older, 72% indicated they would be screened for colorectal cancer if their doctor recommended it. Patients are clearly ready to take action, and we should be, too.

There is enormous opportunity to save lives, because this is one cancer that can be prevented.

Screening can detect and remove precancerous polyps and, therefore, prevent or detect cancer at the earliest, most treatable stage. Yet only 39% of colorectal cancers are detected early.

The alternative is tragic: Once a cancer metastasizes, the five-year survival rate is less than 10%, compared with a 90% survival rate if tumors are found early.

So what keeps doctors from talking to patients about the critical need for colorectal cancer testing? Obstacles abound. But, discussions with physicians who have overcome them turned up these ideas:

• Educational materials and checklists can engage and motivate patients despite limited time with them. Some practitioners have developed a checklist of screening exams that both the patient and the doctor sign and initial. The agreement is placed in the patient's file and reviewed during subsequent checkups. The American Cancer Society's Great American Health Check, available online (www.cancer.org/healthcheck), asks patients a few quick questions and gives action plans that explain which cancer screenings are right for them based on age and family history.
• Insurance fears are often unfounded. Many insurers and Medicare cover routine screenings, including colonoscopies.