Many women who regularly get checked for breast cancer and cervical cancer still don't go for a test that could save them from another big killer—colon cancer—according to new University of Michigan research. But perhaps their mammogram and Pap smear appointments could be used as "teachable moments" to help prompt them to get their colons checked, the researchers suggest.

In all, women who get the recommended screenings for breast and cervical cancer are still far more likely than other women to have their colons examined through colonoscopy or other methods, the U-M team reports.

But a large percentage of even these apparently health-conscious women fail to get screened for colon cancer, the No. 3 cause of cancer death in women after lung cancer and breast cancer.

American Cancer Society guidelines call for women (and men) over 50 who have no elevated risk factors to have a colonoscopy every 10 years, or a sigmoidoscopy every five years, or a test of their feces each year.

The researchers suggest that doctors use the occasion of one cancer screening to educate and motivate women to have another.

"Women have internalized the public health message that they should go for regular mammograms, and that they should have Pap smears, because that's what normal women do for themselves," says Ruth C. Carlos, M.D., M.S., the
U-M Health System radiologist who led the research. "Now, they need to add colorectal screenings to the list – and we think that there's tremendous opportunity for physicians and health systems to use women's other screening appointments to increase their awareness."

Data from the Centers for Disease Control and Prevention's 2001 Behavioral Risk Factors Surveillance Survey shows only 46 percent of women had been checked for colon cancer as recommended, while nearly 70 percent were up-to-date with cervical cancer screening, and more than 82 percent had been getting their breasts checked regularly.

"Screening mammogram is so accepted, we can use it as a teachable moment to educate women about colorectal cancer risk," says Carlos. "They've already accepted going in to see a doctor for a breast cancer check, and tolerating discomfort for the sake of their future health, so why don't we use that time as a means to reach out to women who might not be aware of their colon cancer risk and the fact that screening and early detection saves lives?"

The fact that most women go for mammograms and Pap smears year after year is great, but getting them in the door for their first colonoscopy may hold even more life-saving value, adds Mark Fendrick, M.D., M.S., Carlos's co-author and a professor of internal medicine.

"Many women undergo repeated testing for one disease, and completely neglect screening tests for other treatable cancers," he says. "We need greater emphasis on initial testing for multiple conditions. That will maximize the benefits of screening."

Carlos is currently leading a clinical trial that randomizes women to receive education during their mammogram appointments about either colorectal cancer screening or diabetes screening. The researchers will review the women's records up to a year later to see if they get checked for colon cancer or spoke to their physicians about it.

If this approach works for colon cancer screening, it could also work for other tests that are under-utilized even though they're known to catch or prevent disease early, or allow for effective intervention, says Fendrick. From bone density scans to adult vaccines, he notes, "If we have a test that's at 80 percent adherence and another that's at 20, we should go to the 80 percent to encourage them to have that other test."

For more information:

CCC Breast Cancer Information: Mammograms
http://www.cancer.med.umich.edu/learn/mammogram.htm

CCC Colon or Rectal Cancer information
http://www.cancer.med.umich.edu/learn/coloninfo.htm

U-M Health Topics A-Z: Colonoscopy
http://www.med.umich.edu/1libr/aha/aha_colonosc_crs.htm