Office of Research & Development

Feature Article

VA meeting goals for colorectal cancer screening

Colorectal, or colon, cancer refers to cancer that is found in either the colon or the rectum. According to the American Cancer Society (ACS), this type of cancer is the third most common cancer diagnosed in the United States. This year, ACS estimates 101,340 new cases of colon cancer and 39,870 new cases of rectal cancer will we diagnosed.i

Colorectal cancer is also the second leading cause of cancer-related death in the United States, and ACS expects the disease to cause about 49,380 deaths during 2011.ii Over the past 20 years, however, the death rate has been declining—both because of improved treatments and because of improved detection methods. If colorectal cancer is detected early, it is one of the most treatable of all cancers.

VA has made it a priority to screen its patients aged 50 years or above for colorectal cancer. A new study, published electronically and soon to be published in print in the journal Digestive Diseases and Sciences, shows that VA is, in fact, meeting its goals for conducting such screens. The study also analyzed the background of Veterans who did not complete and return a fecal occult blood test (FOBT) card to their VA physicians. FOBT is a common screening test for colorectal cancer.iii

The study was based on data collected by VA's Office of Quality and Performance from selected patients who visited VA health care facilities from October 2008 through September 2009. The team analyzed the records of more than 36,000 Veterans. They found that 80.4 percent of those Veterans had received some form of colorectal cancer testing.

"Overall, the rates of screening for colorectal cancer in VA are high," said Millie D. Long, MD, MPH, the principal author of the study. "In addition, the characteristics we've found in those who do not adhere to the FOBT may help us to improve completion rates in the future." Dr. Long completed a preventive medicine residency rotation at VA's National Center for Health Promotion and Disease Prevention, and is currently an assistant professor of medicine at the University of North Carolina.

VA physicians usually choose from among three types of screening procedures for colorectal cancer. They include:

  • An annual fecal occult blood test, which detects blood that is not visible in a stool sample;
  • A flexible sigmoidoscopy examination every five years. This procedure allows physicians to visually inspect the interior walls of the rectum and the lower part of the colon using a thin, flexible, lighted tube called a sigmoidoscope;
  • A colonoscopy examination every 10 years. This procedure allows physicians to visually inspect the interior walls of the rectum and the entire colon using a thin, flexible, lighted tube called a colonoscope.

If a patient had completed any of these three procedures within the time frame specified for the test (in other words, if a patient received a colonoscopy examination within the previous ten years, a sigmoidoscopy within the past five years, or a fecal occult blood test within the past year), he or she was considered to have been correctly screened for the disease.

Of the approximately 80 percent of Veterans who had received one of these types of screens, the team learned that nearly 72 percent had undergone a colonoscopy within the last 10 years. Colonoscopies were counted towards this measure even if they were performed for reasons other than screening. Within the year before the study took place, nearly a quarter of all patients had completed a FOBT, making that the second most frequently used type of screening.

To complete a FOBT, patients put tiny samples of their stool on a special card or cloth. The card or cloth is then sent to a medical laboratory, which uses chemicals to detect blood that cannot be seen with the naked eye. If the lab tests are positive for blood, VA regulations require the test to be followed up with a prompt diagnostic evaluation—usually through a colonoscopy—and expeditious treatment if cancer is found.

The study looked at the demographics of those patients who were given a FOBT card by their physicians and did not return it. Groups that tended not to return cards as frequently as others included younger Veterans; women; non-Caucasians; those who lived in the Northeast; people who currently smoke; and those who had not been recently vaccinated for influenza.

Symptoms of colon cancer are numerous and non-specific. They include fatigue, weakness, shortness of breath, changes in bowel habits, narrow stools, diarrhea or constipation, red or dark blood in the stool, unexplained weight loss, abdominal pain, cramps, or bloating. People who experience these symptoms for any length of time, even a few days, should call their doctors right away to discuss their concerns and arrange for testing.


i American Cancer Society Web Site: http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-key-statistics ii Idem. iii MD Long, T Lance, D Robertson, L Kahwati, L Kinsinger, DA Fisher, "Colorectal Cancer Testing in the National Veterans Health Administration," Dig Dis Sci, 2011 Sep 16. (Epub ahead of print.)

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