Healthcare Providers play role in likelihood of Colorectal Cancer Screening

A new study published in Cancer reports that the likelihood of patients' obtaining colorectal cancer screenings is dependent on health care providers. Dr. Melissa M. Farmer of Veterans Affairs and colleagues suggest that interventions targeting both the provider and the patient are needed to boost colorectal cancer screening rates. Specifically, patient barriers such as concerns about payment and worries that cancer will be discovered must be taken into account.

Despite colorectal cancer being the third leading cause of cancer death in both US men and women, national screening rates remain relatively low. However, there has been growing recognition of the importance of screening in reducing cancer mortality.

Dr. Farmer and colleagues were chiefly interested in the potential barriers to colorectal cancer screening. The researchers analyzed data from a study conducted at UCLA's Jonsson Comprehensive Cancer Center and the UCLA School of Public Health. They examined trends and predictors of colorectal cancer screening from telephone surveys done prior to and after a quality improvement intervention for screening. Survey participants were all members of a large managed care health plan, allowing the researchers to assess barriers to screening in an environment where access to care was not one of them.

Two surveys were conducted. The first contained 498 individuals aged 50 years and older surveyed in 2000. The second consisted of 482 different individuals in the same age group surveyed in 2003. The researchers used specific guidelines to assess whether individuals received colorectal cancer screening - a fecal occult blood test every year, sigmoidoscopy every 5 years, or colonoscopy every 10 years.

A fecal occult blood test is a check for hidden blood in the stool, a sigmoidoscopy is a minimally invasive medical examination of the large intestine from the rectum through the last part of the colon, and a colonoscopy is an examination of the large colon and the distal part of the small bowel with a camera.

Key findings include:

* Colorectal cancer screening rates increased over the three-year period, though there was evidence of underutilization
* 38% of patients in 2000 reported that they had been screened with any test
* 50% of patients in 2003 reported that they had been screened with any test
* Patients who reported discussing colorectal cancer screening with doctors were significantly more likely to have a screening.
* Participants who were concerned about cost or who were afraid of a cancer diagnosis were less likely to be screened.

The results "suggest that interventions focused solely on educating patients are not likely to increase rates significantly," according to the authors. "The provider and related health care system must be able to include discussions and recommendations for colorectal cancer screening in practice." They conclude by calling for multilevel interventions that target both the provider and patient in order to increase screening rates.

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