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U-M study: Katie Courics colonoscopy caused cross-country climb in colon cancer checks
"Katie Couric Effect" shows celebrity endorsement affects health behavior
ANN ARBOR, MI When NBC television personality Katie Couric underwent a colonoscopy live on national television in March 2000, she did more than raise public awareness of the powerful colon-cancer screening test she also raised the rate at which Americans signed up to get their own colons checked.
Thats the finding of a new study from researchers at the University of Michigan Health System and the University of Iowa. In the July 14 issue of the Archives of Internal Medicine, the team reports that colonoscopy rates nationwide jumped more than 20 percent in the days and months after Courics on-air test on the "Today Show." The researchers have dubbed the phenomenon the "Katie Couric Effect."
The results also show that the higher rate of colonoscopies was sustained for nearly a year after the show, and that the proportion of colonoscopies performed on women and people under age 50 rose echoing "Today Show" audience demographics.
"These findings suggest that a celebrity spokesperson, even one without the specific disease that he or she is promoting, can have a sizable impact on the public behavior related to that disease," says Mark Fendrick, M.D., the U-M physician who helped lead the research team.
Adds lead author Peter Cram, M.D., M.B.A., a former U-M internal medicine lecturer now at U-Is College of Medicine, "Considering that fewer than half of Americans currently get appropriate screening for colon cancer, the second-leading cause of cancer deaths, Ms. Courics efforts are especially significant."
However, the authors note, their study doesnt reveal whether the "Today Show" viewers inspired by Couric to get colonoscopies were those whose risk of colon cancer was highest. Although colonoscopy can catch and remove pre-cancerous polyps in any colon, current national guidelines recommend it mainly for people age 50 and over, who face the highest risk and should get checked every 10 years.
The new study is mainly based on the number of colonoscopies performed each month by 400 gastroenterologists at 42 sites in 22 states, in a time period starting 20 months before Courics colonoscopy and continuing until nine months after the show aired. The data came from the Clinical Outcomes Research Initiative, a subsidiary of the American Society for Gastrointestinal Endoscopy.
The new results confirm, and add national perspective to, initial data from a much smaller study of Midwestern HMO members. That study was presented by the same team at a major meeting in early 2002, and the results are included in the new paper.
More than 130,200 Americans will be diagnosed with colon cancer this year, and 56,300 will die from the disease, according to the National Cancer Institute.
Many patients dont find out they have the disease until their tumors have grown large enough to cause symptoms such as blood in their stool, persistent abdominal cramps and changes in bowel habits. At that stage, treatment often fails to save their lives. But if the disease is caught in its early polyp stage, via colonoscopy or other methods, it can be cured in most cases.
Couric became a colonoscopy crusader of sorts after the death of her husband Jay Monahan from colon cancer at age 42. Her on-air colonoscopy was the cornerstone of a weeklong series on the "Today Show" that promoted colon cancer awareness and endorsed colorectal cancer screening. Couric has since founded the National Colorectal Cancer Research Alliance, part of the Entertainment Industry Foundation, and the Jay Monahan Center for Gastrointestinal Health in New York.
Fendrick and Cram cite Couric for bringing attention to a screening test that has been proven effective at saving lives, but goes unused by millions of Americans at high risk of colon cancer. "This test, which requires healthy people to undergo an invasive, uncomfortable and often embarrassing exam, especially needed a celebrity advocate to reduce the stigma and fear, and thereby increase participation," says Fendrick, an associate professor of internal medicine at the U-M Medical School who co-directs the U-M Center for Healthcare Outcomes, Innovation and Cost Effectiveness Studies.
The authors note that their study differs from other research that has shown that celebrity spokespeople who have a certain disease can increase public interest in that disease and change public behavior. Because Couric herself is healthy, like many of the adults who should be getting regular colonoscopies, her awareness campaign faced the challenge of exhorting people to have a test that many would rather avoid.
But the new data show thats exactly what happened. Among the 400 gastroenterologists, the number of colonoscopies performed each month rose from an average of 15 before Courics exam to 18.1 after. The number of colonoscopies per month per 1,000 members of the HMO rose from 1.3 before to 1.8 after.
The increase in the proportion of colonoscopy recipients who were female did not achieve statistical significance, but Fendrick and Cram call it an interesting trend. The proportion of female patients examined by the CORI doctors rose from 43.4 percent to 47.4 percent, and the percentage rose from 49.1 percent to 51.6 percent among the HMO members.
While the average age of colonoscopy recipients among the HMO members did not change, the same measure dropped significantly, from 60.8 years to 59.9 years, among CORI patients. The authors also found that the proportion of CORI colonoscopy patients who were under age 50 increased from 21.6 percent to 22.4 percent, a statistically significant jump.
While people younger than 50 have been shown to benefit somewhat from routine colonoscopy, and individuals like Monahan do get the disease and die from it at a young age, the authors stress that the age group most likely to benefit from colonoscopy is the over-50 group. The shortage of skilled endoscopists and scarce health care dollars also add to the argument that younger people should not be the main target audience for messages about colonoscopy.
This raises the issue of how celebrity health messages are crafted, and how well they encourage appropriate, proven practices.
"Celebrity spokespeople should deliver carefully targeted, evidence-based recommendations that will ultimately improve public health," says Fendrick. "Given the impact they can have on all types of health behavior, its important that celebrities team with medical professionals and societies to develop their campaigns."
In addition to Cram and Fendrick, the research team included U-M gastroenterologist John Inadomi, M.D.; U-M general internist Mark E. Cowen, M.D., S.M., who is also affiliated with St. Joseph Mercy Hospital in Ann Arbor; Daniel Carpenter, Ph.D., of the U-M Departments of Political Science and Public Policy; and U-M internist Sandeep Vijan, M.D., M.S. Vijan and Inadomi are also affiliated with the VA Ann Arbor Healthcare System, while Fendrick also holds a position in the U-M School of Public Health.
The authors have no relevant funding interests in the study subject, and no funding agency funded the study specifically. During the time when the study was conducted, Cram was supported by a fellowship grant from the Agency for Healthcare Research and Quality, and Vijan is a Veterans Affairs Health Services Research and Development Career Development awardee.
Reference: Arch. Intern. Med, Vol. 163, July 14, 2003
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