SAN DIEGOEffective screening for colorectal cancer requires ongoing testing and follow-up. Robert E. Schoen, MD, MPH, of the University of Pittsburgh, reported that adherence with sigmoidoscopy is outstandingabout 86% of eligible subjects returned for a follow-up exam at 3 years. However, a negative experience with screening flexible sigmoidoscopy can keep patients from repeating the procedure. He discussed the findings at an American Gastroenterological Association research forum held during Digestive Disease Week.
Dr. Schoen and his colleagues measured compliance with repeat screening sigmoidoscopy and the factors affecting compliance in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial.
PLCO is an NCI community-based randomized clinical trial with 10 US screening centers, Dr. Schoen said. It offers periodic multimodality cancer screening, including flexible sigmoidoscopy. In the initial years of the trial, sigmoidoscopy was offered at 3-year intervals.
Of the more than 10,000 subjects between the ages of 60 and 74 who had undergone a baseline flexible sigmoidoscopy examination and were eligible for a repeat examination, 8,804 (86.6%) accepted when the repeat exam was offered 3 years later, he reported.
The study showed that 1,360 people refused to repeat the sigmoidoscopy exam or did not show up for the clinic visit for their repeat exam. Those most likely to refuse were women (18.3%), non-Hispanic blacks (21.7%), current smokers (21.8%), and people with technically inadequate baseline sigmoidoscopy exams (26.8%).
The researchers found that age and education were neither strongly nor consistently associated with refusing the repeat screening procedure.
We found that one reason for a high refusal rate is patient discomfort, Dr. Schoen said. An inadequate exam the first time that was associated with pain was more likely to lead to nonadherence 3 years later. Further research should be done to generalize results to community settings and test interventions to encourage repeat screenings.