Failure of screening or failure to screen? The screening behavior of patients with colorectal cancer in the Leipzig area.

BACKGROUND: Colorectal cancer (CRC) is the second most common cancer-related cause of death in Germany. Screening for colorectal cancer is effective and is covered by statutory health insurance in Germany.
METHODS: The authors studied the screening behavior of patients with CRC in the Leipzig area in the 10 years before their diagnosis. The patients were asked to fill out a standardized questionnaire, and their primary care physicians were questioned, in order to determine what screening measures had been performed and why none had been performed in some cases.
RESULTS: 212 patients with CRC were studied. In 175 (83%), cancer had been diagnosed after the appearance of symptoms ("symptomatic group"); in 37 (17%), it had been detected by screening ("screening group"). 51% of the overall patient group had undergone CRC screening in the 10 years before their diagnosis. A test of the stool for occult blood was the most common screening method but was generally not performed in conformity with guidelines. 25 patients (12%) had undergone a screening colonoscopy in the 10 years before their diagnosis; of these 25, 20 had undergone a screening colonoscopy in the 5 years before their diagnosis. The main reason why screening was not performed was ignorance of its availability.
CONCLUSIONS: This retrospective study revealed that, of 212 patients with CRC, most had not previously undergone CRC screening in conformity with guidelines. Better patient education by physicians may improve the effectiveness of screening. Appropriate screening measures include fecal occult blood testing and colonoscopy in conformity with guidelines.