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A national study involving 804 couples found that married men over age 55 were almost 20 percent more likely to have had a screening colonoscopy in the previous five years than men who were not married. Men married to women who are happier with the marital relationship were nearly 30 percent more likely. That rises to more than 40 percent if their wives were highly educated.
For women, however, being married, happily or otherwise, made no significant difference compared with unmarried women. Neither the relationship happiness nor education levels of their husbands appeared to change colonoscopy rates for wives.
"Women are thought to control the health capital in most households," explained study director William Dale, MD, PhD, chief of geriatrics & palliative medicine at the University of Chicago. "They act as health gate keepers, overseeing their husband's health choices and directing decisions at the margins. Her decisions influence both partners."
"In contrast, women appear to derive fewer direct health benefits from marriage," he said. "We suspect they depend more on alternate support sources, such as friends and other relatives."
The study used data collected in 2010 from the National Social Life Health and Aging Project (NSHAP), a nationally-representative sample that includes older couples in the U.S. The researchers surveyed 804 male-female couples, drawn from a sample of more than 3,000 community-dwelling adults, aged 55 to 90. Average age was 72 for men and 69 for women.
"We hoped that a better understanding of the role of spouses might help us improve cancer screening rates," Dale said. This strategy has been valuable for other health interventions, such as smoking cessation, encouraging exercise, and nutrition counseling. It had not previously been shown for colon cancer screening.
Although colorectal cancer is the second-leading cause of cancer deaths among American men and women, nearly 40 percent of those who meet the screening guidelines do not get the procedure. Last year, about 133,000 Americans were diagnosed with colorectal cancer. An estimated 50,000 died. The United States Centers for Disease Control (CDC) encourages regular colorectal cancer screening once every ten years beginning at age 50, earlier and more often for those at higher risk.
Because colorectal cancers can often be prevented or cured when diagnosed early, the National Colorectal Cancer Roundtable, a coalition of organizations co-sponsored by the CDC and the American Cancer Society, has proposed adoption of a national goal to achieve 80 percent colon cancer screening rates by the end of 2018.
In Illinois, according to the American Cancer Society, 1,032,400 people need to be screened to achieve 80 percent by 2018. Nationwide, 24 million people need to be screened to reach the goal. Staying current with screening involves either a colonoscopy once every 10 years or a yearly stool test.
This is an uphill battle. Although screening colonoscopy is one of the most effective tools for preventing cancer or catching it early, it is more complicated, more expensive and takes longer than, for example, a simple blood test for possible prostate cancer. Colonoscopy uses a four-to-six foot, flexible tube, about half an inch wide, with a camera and a light source at its tip, to examine the inside of the colon.
"Screening takes time, involves preparation and recovery, and comes with an 'ick factor,'" Dale said. It begins the day before, with a bowel cleansing, which means drinking a volume of polyethylene glycol, an electrolyte-rich fluid that flushes out the colon. Most people are sedated during the actual testing, and thus require a ride home afterwards. They tend to take the rest of that day off. Overall, it's an involved process requiring assistance, especially for older adults. "We suspect that women who are more emotionally invested in their marriage are more likely to encourage healthy behaviors in their husbands," Dale said. "Husbands are more likely to take this advice when they view their wives as supportive."
"Men don't like to discuss cancer screening generally or colonoscopies in particular," Dale said. "They don't tend to talk to each other about it. It is not an easy topic of conversation. But our data suggest that they will more often do it with proper encouragement and support from their spouse. Our goal now is to engage the wives, to have them in the office when we discuss cancer screening with the husband."