RESEARCHERS CITE NEW COLORECTAL CANCER SCREENING DATA.

Byline: Peter Modica Medical Tribune News Service

Many doctors may not be screening patients appropriately for colorectal cancer, even though guidelines have been established and early detection and treatment can dramatically reduce a person's risk of dying from the disease, Cleveland researchers report.

In a survey of 884 primary-care doctors in 10 states, no more than 60 percent said they would recommend flexible sigmoidoscopy in healthy patients ages 65 to 75, despite evidence that the test is of benefit. The test uses a thin device to examine the rectum and lower colon.

And 30 percent of doctors said they would recommend using another screening exam - fecal occult blood test - in terminally ill patients who most likely would not benefit from the test, according to findings published in the current issue of the Archives of Internal Medicine.

Screening guidelines supported by the American Cancer Society, the American Gastroenterological Association and other groups state that the blood test should be offered to healthy people every year starting at age 50, and that flexible sigmoidoscopy should be offered every three to five years in this age group.

The tests should be offered earlier in people with risk factors, such as family history of the cancer, according to the recommendations.

``One of the problems is the recommendations are vague,'' and don't specify the age to stop screening or when not to screen, said lead researcher Dr. Gregory S. Cooper, an assistant professor of medicine at Case Western Reserve University in Cleveland.

In an accompanying editorial, James R. Marshall and colleagues at the Arizona Cancer Center in Tucson, wrote that ``primary-care physicians need clear guidance regarding the value and appropriate use of colorectal screening.''

Dr. Robert Fletcher, who co-chaired the committee on the recently published guidelines, noted that doctors should ``exercise wisdom and judgment'' in tailoring screening to the individual patient, using one of these tests, or both.

``Screening is effective, it saves lives, and everyone over age 50 should consider it,'' said Fletcher, a professor of ambulatory care and prevention and epidemiology at Harvard Medical School in Boston.

But ``under circumstances of very advanced age and illness, it may not be appropriate to screen,'' he said.

An estimated 131,200 cases of colorectal cancer will be diagnosed in the United States in 1997 and 54,900 people will die from the disease, according to the American Cancer Society.