Are we doing enough to screen for colorectal cancer? Findings from the 1999 Behavioral Risk Factor Surveillance System

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Original Research

Are we doing enough to screen for colorectal cancer? Findings from the 1999 Behavioral Risk Factor Surveillance System

J Fam Pract. 2002 September;51(9):761-766

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References

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The 1999 BRFSS was the first BRFSS survey to collect data on the use of colonoscopy. Because BRFSS colonoscopy data have not previously been collected, we do not know whether the reported increase in the use of endoscopy from 1997 to 1999 represents a true increase in sigmoidoscopy usage or previously unmeasured colonoscopy usage. Furthermore, it is likely that some of the tests reported as sigmoidoscopies or proctoscopies in the 1997 BRFSS survey were actually colonoscopies, since some respondents may be unable to clearly distinguish between the endoscopic tests.

Both patient-related and physician-related factors likely contribute to continued underuse of these tests. Patient-related factors include lack of awareness of screening guidelines, embarrassment, and lack of physician recommendation.^7,18-20 Physician-related factors include lack of knowledge of the effectiveness of screening, lack of skills in endoscopy, and low reimbursement rates for screening tests.^7,18-21

Several factors limit the interpretation of this analysis. First, as this is a telephone survey, only people who have access to telephones are represented in this analysis. However, approximately 95% of households in the United States have telephones.²² Second, 43.3% of the eligible respondents who were successfully contacted did not complete the telephone interview. Third, responses are self-reported and not validated through medical record review. However, a comparison of self-report and record review has found good concordance between results.²³ Fourth, in the 1999 BRFSS, sigmoidoscopy use cannot be measured separately from colonoscopy, and screening tests cannot be distinguished from diagnostic tests. The results reported here may therefore be overestimates of use of these tests for screening. Lastly, the specialty of the physicians ordering the tests is unknown, limiting the ability to target interventions towards specific physician specialists. Despite these limitations, the BRFSS provides an excellent data source for routine surveillance of CRC testing.

Conclusion

This report demonstrates that CRC screening tests remain underused, despite their recognized efficacy in reducing CRC incidence and mortality.^2-8 Coordinated efforts by clinicians and policy makers to raise awareness about this important disease and promote use of available screening tests must continue.

CORRESPONDENCE
Epidemiology and Health Services Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Data from this paper were presented at CDC’s 15th National Conference on Chronic Disease Prevention and Control on November 30, 2000. Send correspondence and reprint requests to: Laura C. Seeff, MD; Centers for Disease Control and Prevention, DCPC; 4770 Buford Highway NE; Mailstop K-55; Atlanta, Georgia 30341-3717. E-mail: lvs3@cdc.gov.