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more than 15,000 sigmoidoscopies performed for routine colorectal cancer screening between 1997 and 2001. She found that the percentage of exams that failed to reach 50 centimeters into the colon increased from 10 percent in men aged 50 to 59, to 22 percent in those 80 years or older. The corresponding percentages of inadequate examinations in women climbed from 19 percent in the younger age group to 32 percent in women 80 years and older.

"I had been finding that a lot of my older patients were not getting adequate exams," Walter says, "and I wanted to know whether this was a widespread problem. I was initially approaching this as an age issue. But then the gender differences popped up. The most disturbing thing this study shows is that women are twice as likely as men to have an inadequate exam." The study is published in the Feb.1 issue of the American Journal of Medicine.

Colorectal cancer is the second most common cause of cancer-related death in the United States and almost 80 percent of colorectal cancer deaths occur in people older than 65 years. Yet there is disagreement about the best way to screen for these cancers. Some professional and governmental organizations recommend colonoscopy -- a procedure that examines the entire colon and is performed on patients under sedation -- while others recommend screening with flexible sigmoidoscopy every 5 years or annual fecal occult blood screening, or both.

"It was always a dilemma for me when a patient asked which test I recommended," Walter says. "Other studies have never given a clear answer. Many guidelines say that it depends on the patient's preferences. It does depend on the patient's preferences, but it also depends on which test is most likely to succeed. My study didn't look at the benefits or harms [potential complications of the procedure] of this test. It looked at adequacy, and for these particular populations [older people, and particularly older wo
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Contact: Liese Greensfelder
lgreensfelder@pubaff.ucsf.edu
415-476-8429
University of California - San Francisco
26-Jan-2004

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