Colorectal cancer is the second leading cause of cancer-related death (after lung/bronchus cancer) in the United States. In 2002, a total of 139,534 adults in the United States had colorectal cancer diagnosed, and 56,603 died. The US Preventive Services Task Force and other national organizations recommend that adults aged ≥ 50 years be screened for colorectal cancer with one or more of the following tests: fecal occult blood testing (FOBT) every year, sigmoidoscopy or double-contrast barium enema every 5 years, or colonoscopy every 10 years.[2-4]
To estimate current rates of use of colorectal cancer screening tests and to evaluate changes in test use, the Centers for Disease Control and Prevention (CDC) compared data from the 2002 and 2004 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report describes the results of that comparison, which indicated that the proportion of BRFSS respondents reporting use of FOBT and/or sigmoidoscopy or colonoscopy had increased overall from 2002 to 2004. Measures to increase awareness and encourage regular colorectal cancer screening must be continued to reduce mortality from colorectal cancer.
In 2004, a total of 49 states (BRFSS data for Hawaii were not available for 2004) and the District of Columbia (DC) participated in BRFSS, a state-based, random-digit-dialed telephone survey of the noninstitutionalized, US civilian population aged ≥ 18 years. Interviewers asked 146,794 participants aged ≥ 50 years whether they had ever had a blood stool test using a home test kit (ie, FOBT), whether they had ever had a sigmoidoscopy or colonoscopy, and when the latest test had been performed. Respondents who refused to answer a question or did not know the answer to a question (approximately 3% overall) were excluded from analysis of the specific question. Aggregated percentages and 95% confidence intervals were calculated.
Results from the 2004 BRFSS survey were compared with results from 2002. Data were weighted to the sex, racial/ethnic, and age distribution of each state's adult population using intercensal estimates and were age-standardized to the 2000 US standard population. The median state Council of American Survey Research Organizations (CASRO) response rate for the entire survey was 52.7% (range: 32.2% in New Jersey to 66.6% in Nebraska). Survey questions and response options were identical for the two surveys. In both 2002 and 2004, respondents were asked if they had ever used a "special kit at home to determine whether the stool contains blood (FOBT)," whether they had ever had "a tube inserted into the rectum to view the colon for signs of cancer or other health problems (sigmoidoscopy or colonoscopy)," and when these tests were last performed. For this report, sigmoidoscopy and colonoscopy are described as "lower endoscopy."
Percentages were estimated for persons aged ≥ 50 years who reported receiving an FOBT within 1 year preceding the survey and/or lower endoscopy within 10 years preceding the survey. Because BRFSS does not differentiate between sigmoidoscopy and colonoscopy, the surveillance period used was 10 years, the recommended interval for colonoscopy.
In 2004, 57.3% of adults aged ≥ 50 years reported having had an FOBT within 1 year preceding the survey and/or a lower endoscopy within 10 years preceding the survey (Table 1), compared with 54.4% in 2002. The proportion of persons aged ≥ 50 years who had received FOBT within 1 year preceding the survey declined to 18.7% in 2004 from 21.8% in 2002; however, the proportion who reported receiving lower endoscopy within the 10 years preceding the survey increased to 50.6% in 2004 from 45.2% in 2002.
By state, the proportion of respondents who reported having had an FOBT within 1 year preceding the survey and/or lower endoscopy within 10 years preceding the survey ranged from 47.9% in Mississippi to 68.2% in Minnesota (Table 1). Among states/areas that participated in both surveys, 14 states and DC determined that ≥ 60% of persons reported having had an FOBT within 1 year preceding the survey and/or a lower endoscopy within the 10 years preceding the survey, compared with seven states and DC in 2002 (Figure 1).
Reported by: L.C. Seeff, MD, J. King, MPH, L.A. Pollack, MD, K.N. Williams, MA, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.