Veterans' Colon Cancer Screening Up

But Many Veterans Don't Choose the Best Test -- Colonoscopy

Nov. 13, 2006 -- Most U.S. veterans aren't getting the best colon cancer screening test, a nationwide survey shows.

By law, the federal government must pay for any colon cancer screening test a U.S. veteran chooses to undergo. That has resulted in a huge increase in the percentage of veterans who get the tests, which catch colon cancer in its earliest, curable stages.

Among the colon cancer screening options, virtually all experts say that colonoscopy is the best choice. That's because a colonoscopy looks at the entire colon and it immediately removes any suspicious polyps.

Other screening tests -- notably the fecal occult blood (FOB) test, sigmoidoscopy, and barium-enema tests -- also cut cancer deaths. But they miss more cancers than colonoscopy.

Baylor College of Medicine researcher Hashem B. El-Serag, MD, MPH, and colleagues looked at colon-screening data collected by the Veterans Administration from 1998 to 2003.

The good news: Colon cancer screening is way up among veterans. However, screening rates went up only for FOB tests -- from 82% of vets to 90% of veterans. In 2003, only about 5% of veterans got colonoscopies.

In an editorial accompanying the study, Hemant K. Roy, MD, of Evanston-Northwestern Healthcare in Evanston, Ill., and colleagues say it's a good thing more veterans are getting colon cancer screening.

"However, several lines of evidence unequivocally indicate that the FOB test is an inferior test [compared with] colonoscopy," Roy and colleagues conclude. "Colonoscopy is clearly the best test. … [But] there is still a role for the less invasive and less accurate tests, especially in lower-risk patients or in those unwilling or unable to undergo more definitive screening."

The El-Serag study, and the Roy editorial, appear in the Nov. 13 issue of Archives of Internal Medicine.