DENVER — Physicians often miss the opportunity to recommend colorectal cancer screening in patients with cardiovascular risk factors, a national survey indicates.
Screening for colorectal cancer (CRC) in patients with cardiovascular risk factors is particularly important because many of the traditional cardiovascular risk factors are associated with an increased risk of the malignancy, which is the second-leading cause of cancer deaths in the United States, Dr. Omotayo Olatinwo said at the annual meeting of the American Association for Cancer Research.
She presented an analysis of data from the National Center for Health Statistics' 2005 National Health Interview Survey. Of 1,421 patients aged 50–79 years and considered to be at average risk for CRC and eligible for CRC screening, only 70% received a physician recommendation for it.
The only cardiovascular risk factor associated with an increased likelihood of a physician recommendation for CRC screening was dyslipidemia. Dyslipidemic patients were 44% more likely to be recommended for CRC screening than were nondyslipidemic individuals.
In contrast, diabetic patients were 27% less likely to be offered CRC screening, according to Dr. Olatinwo, a third-year general internal medicine resident at Morehouse School of Medicine, Atlanta. “Unfortunately, we physicians missed the opportunity to screen people who have diabetes, who smoke, and who are obese,” she commented in an interview.
Other key findings from the study were that patients who graduated from high school were 80% more likely than were less educated individuals to receive a physician recommendation for CRC screening, and patients with four or more office visits within a year were more likely to be offered screening than were those with three or fewer office visits.
In the next several years, much more widespread use of electronic medical records—featuring physician prompts and reminders—are expected, and this should greatly reduce these missed opportunities for CRC screening, Dr. Olatinwo said.
She also noted that solid evidence indicates CRC and cardiovascular disease are strongly associated through shared risk factors.
An example is a 621-patient study that was conducted by physicians at the University of Hong Kong. They found that the prevalence of colorectal neoplasms on screening colonoscopy was 34% in patients who had angiographic evidence of coronary artery disease, 19% in those with suspected CAD but negative angiography, and 21% in the general population (JAMA 2007;298:1412–9).
The prevalence of advanced lesions was 18.4% in patients with angiographic CAD, 8.7% in those with negative angiography, and 5.8% in the general population. Moreover, CRC was found in 4.4% of the CAD group, 0.5% of those with negative angiography, and 1.4% of the general population.