Colorectal cancer screening in Massachusetts: measuring compliance with current guidelines

Abstract

CONTEXT: Professional organizations have published guidelines for colorectal cancer screening. Defining which patients are currently, or should be, screened is an important clinical and public health issue. OBJECTIVE: To document the prevalence of colorectal cancer screening and profile the tests patients have had. DESIGN/POPULATION: A random-digit telephone survey of Massachusetts adults, 50 years of age and older. OUTCOME MEASURES: Percentage of persons ever and currently tested by fecal occult blood tests, flexible sigmoidoscopy, barium enema, colonoscopy, or some combination of these tests. RESULTS: Sixty-five percent of those contacted agreed to the telephone interview. Approximately 29% of the 1119 respondents had never had any currently accepted test, including 10% who reported having only a fecal occult blood test done in a provider's office and 19% who reported having no tests. At least 51% were currently tested by one or more tests for screening, diagnosis, or both. Another 10% were possibly current by colonoscopy or barium enema, both of which can be ordered for screening but are more commonly used to evaluate a problem, such as rectal bleeding, or for surveillance after identification of a polyp or other abnormality. An additional 11% had been tested at some point but were not current according to guidelines. CONCLUSIONS: Accurate assessment of rates of colorectal cancer screening is complex because of the multiple acceptable screening methods, the fact that patients may be tested for screening or diagnostic purposes, and the lack of adequate systems for tracking such testing. For accurate measurement, all methods must be assessed regardless of whether tests were ordered for screening, diagnosis, or surveillance.