Health Services Research & Development

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Spotlight: Colorectal Cancer Research

March 2013


Resources


According to the American Cancer Society (ACS), colorectal cancer (CRC)—cancer in the colon or the rectum—is the third most common cancer diagnosed in the United States, and the second-leading cause of cancer-related mortality. 1 However, when detected early, it is also one of the most treatable cancers.

Within VA, screening Veterans for CRC is a priority. The methods VA providers use to conduct CRC screenings include:

  • A fecal occult blood test (FOBT). This test detects blood that is not visible in a stool sample.
  • A flexible sigmoidoscopy examination. This procedure allows physicians to visually inspect the interior walls of the rectum and the lower part of the colon using a thin, flexible, lighted tube called a sigmoidoscope.
  • A double-contrast barium enema (DCBE). In this procedure, x-rays of the colon and rectum are taken after air, and liquid containing barium, are both put into the rectum. The barium compound helps an outline of the colon and rectum show up on an x-ray.
  • A colonoscopy. This procedure allows physicians to visually inspect the interior walls of the rectum and the entire colon using a thin, flexible, lighted tube called a colonoscope.

Risk and Screening Schedules

As with many screening and preventive tests, VA providers review a variety of factors to determine a Veteran's risk for CRC, and develop the appropriate screening schedule based on that risk. VA defines CRC risk in two ways—average risk and high risk. Average risk is considered being over age 50, and high risk is considered having a family history of CRC in first-degree relatives (parent, sibling, or child), and those with a personal history of polyps or inflammatory bowel disease. 2

For Veterans at average risk for CRC, the screening options include:

  • A home FOBT test alone every year.
  • A flexible sigmoidoscopy alone every 5 years.
  • A home FOBT every year combined with flexible sigmoidoscopy every 5 years.
  • A DCBE every 5 years.
  • A colonoscopy alone every 10 years.
  • However, for Veterans at high risk for CRC, screening methods and frequency may vary as determined by a patient's primary care provider, but can include a colonoscopy as early as age 40. 3

    To support VA's CRC prevention and treatment goals, investigators within VA's Health Services Research & Development Service (HSR&D) conduct research that contributes to quality improvement, delivery of care, and access to services. Some of these studies include:

    • A four-year study that looked at the impact of health status on colorectal cancer screening in older adults. Findings emphasized the importance of considering health status when making colorectal cancer screening decisions.
    • A study, currently underway, that examines whether VA patients would be accepting of CRC-specific genetic testing.
    • A recently completed study that looks at rates of complete diagnostic follow-up for VA patients with positive fecal occult blood tests.
    • A six-year study that looked at quality of and cost for care in colon cancer patients who use both VA care and Medicare.

    To learn more about colorectal cancer, visit the links located in the Resources Box, at right.


    1 American Cancer Society

    2 VHA screening guidelines for CRC

    3 ibid