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Prostate Cancer Screening Rates Exceed Colorectal Cancer Screening Rates

Despite lack of evidence to support prostate cancer screening, it is more prevalent than colorectal cancer screening in the U.S.

Colorectal cancer screening is supported by evidence from randomized controlled trials and from case-control studies and is endorsed universally in current practice guidelines. Evidence to support prostate cancer screening, however, is lacking, and recommendations from professional societies for prostate cancer screening are divided. Investigators sought to determine whether rates for colorectal cancer screening and prostate cancer screening reflect the evidence. Nearly 50,000 men (age, 40) from 50 states and the District of Columbia were asked by telephone survey whether they had undergone screening with digital rectal examination and prostate-specific antigen (PSA) tests, fecal occult blood tests (FOBTs), sigmoidoscopy, and colonoscopy.

Among men aged 50 to 69 years, 54% reported PSA screening during the previous year, and 45% reported up-to-date colorectal cancer screening (FOBT during the previous year or endoscopic test during the previous 5 years; relative risk, 1.19; 95% CI, 1.16-1.21). In 27 states, men were more likely to be up-to-date for prostate cancer screening than for colorectal cancer screening; colorectal cancer screening was more common only in Minnesota.

Comment: There also is evidence that adherence rates among women for cervical cancer and breast cancer screening exceed rates for colorectal cancer screening. Like prostate cancer screening, neither cervical nor breast cancer screening is as effective or cost-effective as colorectal cancer screening. Our failure to understand and overcome low adherence rates for colorectal cancer screening in the U.S. is the single most important obstacle to achieving gains in colorectal cancer prevention.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology April 15, 2003

Citation(s):

Sirovich BE et al. Screening men for prostate and colorectal cancer in the United States: Does practice reflect the evidence? JAMA 2003 Mar 19; 289:1414-20.

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