Flu shot creates opportunity for colorectal screening

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If one group of practitioners has its way, clinicians may find themselves handing out colorectal cancer (CRC) screening kits along with immunizations next flu season.

In an effort to raise CRC screening rates, investigators oversaw the distribution of home fecal occult blood test (FOBT) kits to 143 men and women aged 50 to 79 years who attended a flu-shot clinic at San Francisco General Hospital between October and December 2006. None of these individuals had had an FOBT since the end of the previous flu season, a colonoscopy in the past 10 years, any previously unevaluated abnormal FOBT results, or a history of recent unevaluated rectal bleeding. Some had undergone flexible sigmoidoscopy within the previous five years. (Many guidelines endorse the use of flexible sigmoidoscopy together with FOBT.)

Another 246 patients attending one of eight other flu-shot clinic sessions during the same period served as the control group (they received only the immunization).

CRC screening rates increased “dramatically” in the intervention group compared with the control group, according to the researchers (Ann Fam Med. 2009;7:17-23). FOBT screening rates rose by 29.8 percentage points in the intervention group (from 54.5% at baseline to 84.3% by the end of flu season) and only 4.4 percentage points (from 52.9% to 57.3%) in the control group.

“Annual flu shot activities represent an opportunity for nonphysician staff to offer a FOBT to eligible patients who need it at a time when they are already thinking about annual prevention,” conclude the investigators. “Combining annual FOBT and flu shot activities could become a powerful way to promote CRC screening in primary-care settings.”

In related news, the National Cancer Institute (NCI) has introduced a new online tool for calculating the five-year, 10-year, and lifetime risks for CRC in men and women age 50 years and older. Although individuals can self-administer the instrument, clinicians can also use it to help determine when and how to screen for CRC and to design CRC screening and prevention trials. The NCI calls this the first risk-assessment model to provide an absolute risk estimate for CRC for the general, non-Hispanic white population age 50 years and older in the United States (J Clin Oncol. 2009;27:686-693).

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