Reconfirming Colorectal Cancer Screening Benefits and Educating Patients About Them

The benefits of colorectal cancer (CRC) screening are accepted widely, but uncertainties remain. What are the magnitude and nature of mortality benefits conferred by screening colonoscopy, and how do we best communicate the benefits of screening to patients?

Researchers assembled a cohort of about 5000 CRC patients (mean age, 71; 99% men) who were receiving care at Veterans Affairs hospitals between 2002 and 2008 and who died of the disease; these patients were compared with about 20,000 age- and sex-matched controls without CRC diagnoses at the same facilities. After adjustment for differing background characteristics in the two groups, case patients were significantly less likely to have undergone colonoscopy before their diagnoses. This held true whether their colonoscopy status was assessed at 6 months, 12 months, or ≥24 months prior to cancer diagnosis. Colonoscopy was associated with an overall adjusted 61% relative reduction in CRC-related mortality (72% for left-sided disease, 46% for right sided).

In another study, researchers developed an 8-minute educational video about CRC screening, supplemented by follow-up electronic messages and a digital portal for a patient to “order” his or her own screening test. The 223 primary care patients eligible for screening who completed the program were more than twice as likely to accept a screening intervention during the next 6 months as were the 227 controls who saw a diet and exercise video instead. The improved uptake of screening held for both colonoscopy (32% vs. 21%) and fecal occult blood testing (36% vs. 11%).