CDC: Colorectal screening rates are hindered by lack of health coverage

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Although colorectal cancer screening tests are proven to reduce colorectal cancer mortality, only about half of U.S. men and women 50 and older receive the recommended tests, according to a report in the July issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research (AACR).

Data derived from a 2005 Centers for Disease Control and Prevention (CDC) National Health Interview Survey of 30, 873 U.S. adults found that only 50 percent of men and women 50 and older had received screening in 2005. Although this was an improvement more than the 43 percent of screened individuals reported in 2000, it is still far from optimal, the researchers said.
Jean A. Shapiro, PhD, an epidemiologist at the CDC, said that a major problem appears to be insurance coverage. Among people without health insurance, the researchers found the rate of colorectal cancer screening was 24.1 percent compared to more than 50 percent of insured Americans, depending on the type of insurance. Among patients without a usual source of healthcare, the screening rate was 24.7 percent compared to 51.9 percent of patients with a usual source of healthcare.

"If we can increase the number of people who have healthcare coverage, we should be able to increase colorectal cancer screening rates," Shapiro said.

Beyond health insurance, researchers at the CDC reported the following factors influenced the use of colorectal cancer screening tests:

  • Education: 37 percent of people with less than a high school education received screening vs. 60.7 percent of college graduates.
  • Household income: 37.4 percent of people earning less than $20,000 in annual household income received screening vs. 58.5 percent of people earning $75,000 or more.
  • Frequency of physician contact: 19.5 percent of patients who had not seen a physician in the past year had received screening vs. 52.5 percent of patients who had seen their physician two to five times in the previous year.

The investigators found that approximately 50 percent of patients who did not receive testing said they had “never thought about it,” while about 20 percent said their "doctor did not order it.”

"Many doctors are aware, but some may still need to be educated about the importance of colorectal cancer screening," said Shapiro.

Interviews were conducted in person with a 68 percent response rate. For the current analysis, Shapiro and colleagues focused on 13,480 patients who were age 50 and older.