Primary care providers do not screen all patients eligible for colorectal cancer screening, the second leading cause of cancer death in the United States, according to a UCLA study appearing May 1 in the peer-reviewed journal Cancer.

In the first study to evaluate barriers and facilitators to colorectal cancer screening in the managed-care setting, researchers at UCLA’s Jonsson Cancer Center found that four factors contributed to doctors not screening patients for the disease. These factors included misperceptions about how effective colorectal screening tests are, providers forgetting when to screen patients, patients — unaware they were eligible for the tests — not requesting screening and inadequate financial reimbursement for the screening procedures.

“These barriers represent a clear target for health plans, provider organizations and individual physicians to create interventions designed to increase screening in current clinical practice,� said Dr. Gareth Dulai, an assistant professor of medicine and the study’s lead author. “These interventions could save lives.�

Interventions suggested in the study included increased educational efforts for patients and physicians, creation and use of a simple screening reminder system and increased reimbursement rates for the screening tests.

Beginning at age 50, patients should ask their doctor about screening.

Dulai and colleagues at UCLA’s Jonsson Cancer Center surveyed 1,340 primary care providers in HMOs for the study, which was funded by a grant from the National Cancer Institute. On average, HMO doctors reported that they recommended colorectal cancer screening to only 79 percent of eligible patients — and approximately only half of those actually completed screening.

Colorectal cancer will strike 146,950 Americans this year alone. More than 56,000 people will die from the disease per year, according to the American Cancer Society. Deaths from colorectal cancer could drop sharply if more people were screened for the disease, Dulai said. Often, colorectal is diagnosed only after symptoms arise. By then, the cancer is at a late stage and few effective treatment options are available.


Cancer is the journal of the American Cancer Society. The study is available at www3.interscience.wiley.com/cgi-bin/jhome/28741.

UCLA’s Jonsson Comprehensive Cancer Center is composed of more than 240 cancer researchers and clinicians engaged in cancer research, prevention, detection, control and education. The center, one of the nation’s largest comprehensive cancer centers, is dedicated to promoting cancer research and applying the results to clinical situations. In 2003 the Jonsson Cancer Center was named the best cancer center in the Western United States by U.S. News & World Report, a ranking it has held for four consecutive years.

For more information on the Jonsson Cancer Center, visit www.cancer.mednet.ucla.edu.