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Chiropractic Research Review

Colorectal Cancer Deaths Justify More Screenings

Prostate and colorectal cancer each kill approximately 30,000 men in the U.S. annually. However, colorectal cancer accounts for a larger majority of premature deaths, and regarding screening for the two cancers, only colorectal cancer screening has been shown through randomized, controlled trials to reduce risk of death.

If medical practice guidelines are evidence-based, colorectal cancer screening should be much more common than screening for prostate cancer.

Utilizing the 2001 Behavioral Risk Factor Surveillance System, a yearly health survey of adults in all 50 states conducted by the Centers for Disease Control and Prevention, information was gathered on 49,315 men age 40 or older. Researchers focused on the percentage of men screened for prostate cancer using PSA (prostate-specific antigen) testing and colorectal cancer using fecal occult blood testing (FOBT), colonoscopy or sigmoidoscopy.

Men age 50 and older were more likely to have ever been screened for prostate cancer than colorectal cancer (75% vs. 63% of subjects, respectively). Subjects of all ages also more commonly had received PSA screening in the past year than FOBT in the past year or colonoscopy/sigmoidoscopy in the last five years. Men were significantly more likely to be up-to-date on PSA testing than colorectal cancer testing in 27 states, compared to being more up-to-date on colorectal screening in only one state.

Men may be more willing to submit to a simple PSA blood test than more inconvenient, invasive testing for colorectal cancer. They also may perceive their risk of death from prostate cancer to be higher because they know others suffering from the condition: Prostate-cancer prevalence is higher than colorectal cancer prevalence in men over 40, perhaps due to widespread PSA testing to identify the condition. The authors conclude, "Physicians should ensure that men who choose to be screened for cancer are aware of the known mortality benefit of colorectal cancer screening and the uncertain benefits of screening for prostate cancer."

Sirovich BE, Schwartz LM, Woloshin S. Screening men for prostate and colorectal cancer in the United States: Does practice reflect the evidence? Journal of the American Medical Association 2003:289(11), pp. 1414-1420. http://jama.ama-assn.org

Chiropractic Research Review

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