HONESTY WITH PATIENTS – ADULT PRIMARY CARE

Following an episode of rectal bleeding, a fifty-six-year-old man is diagnosed with metastatic colon cancer. His family physician of the past thirty years reflects on this case. Upon review of the patient's outpatient records, he realizes that fifteen years ago he noted that the patient's father had colon cancer diagnosed in his sixties, and the physician wrote several entries in the chart that the patient was to have a screening colonoscopy at age fifty. The patient has been seen five times in the past six years (for treatment of upper respiratory infections and check-ups) and the physician now realizes that he never recommended a screening colonoscopy to him.

A Perspective from a Primary Care Physician

Clinical Background

For colon cancer screening, many of the national professional organizations, including the American Cancer Society and the U.S. Preventive Services Task Force, recommend the following screening options for average risk individuals starting at fifty years of age: fecal occult blood testing annually, flexible sigmoidoscopy every five years, annual fecal occult blood test plus flexible sigmoidoscopy every five years, double contrast barium enema every five years, or colonoscopy every ten years. Each one of these tests or combination of tests has different sensitivities and specificities.