About 150,000 Americans are expected to be diagnosed with colorectal cancer this year. Survival after five years varies from 90 percent for cancer that hasn't spread to 10 percent for advanced cases.
According to the results released this week by the journal Cancer, many colon cancer patients aren't getting the screenings recommended after surgery to make sure the disease hasn't returned.
The study found that only 40 percent of the 4,426 older patients in the study got all the doctor visits, blood tests and the colonoscopy advised in the three years after cancer surgery.
A federal database of cancer cases and Medicare records for patients was used to see if the guidelines were being followed. They focused on those 66 and older with less advanced cancer who had surgery that could cure them.
Patients were tracked for three years, beginning six months after surgery. When the study began in 2000, the minimum guidelines called for at least two doctor visits a year, twice yearly blood tests for two years and a colonoscopy within three years. A colonoscopy is now recommended in the first year.
Nearly all patients made the doctor visits and almost three-quarters got a colonoscopy, but many didn't get the blood tests that can signal a return of the deadly colon cancer.
Overall, 60 percent of the patients didn't meet the guidelines. Of those who did, more than half actually got advanced medical scans like CT scans and PET scans that are not recommended for routine screening. The scans could have been done because of signs or symptoms of a recurrence, but the researchers said they suspect they were done for routine follow-up.
There was less screening among older age groups, African-Americans and those with other health problems.
It is unclear whether the doctors simply didn't offer the tests or patients failed to get them was clear. The authors suggested that perhaps the follow-up care was being provided by doctors who aren't specialists and unfamiliar with the guidelines. Whether the providers and insurers have a role is also unknown.
One is also left to wonder how well screening and follow up is performed for other big cancers such as breast, lung and prostate carcinomas. There is no doubt that detecting cancer and recurrence early will improve overall survival and reduce the financial burden of the disease for all concerned.
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