Provider influence and patient barriers affect use of colorectal cancer screening

A new study shows that health care providers play a key role in the likelihood their patients are screened for colorectal cancer. The findings suggest that interventions targeting both the provider and the patient are needed to boost colorectal cancer screening rates, and in particular must take into account patient barriers such as concerns about payment and worries that cancer will be discovered. The study is published in the March 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

Colorectal cancer is the third leading cause of cancer death in both men and women in the United States. While there has been a growing recognition of the importance of colorectal cancer screening in reducing cancer mortality, national screening rates remain relatively low.

To assess the potential barriers to screening, Dr. Melissa M. Farmer, a VA career development awardee, analyzed data from a study conducted at UCLA’s Jonsson Comprensive Cancer Center and the UCLA School of Public Health. Dr. Farmer and colleagues examined trends and predictors of colorectal cancer screening from telephone surveys done prior to and after a quality improvement intervention for screening within a large managed care health plan.

The study design allowed them to examine issues related to screening in a setting in which access to care is not a barrier.

Survey participants included 498 individuals aged 50 years and older surveyed in 2000 and 482 individuals in the same age group surveyed in 2003. The researchers assessed whether individuals received colorectal cancer screening within specified guidelines, including a fecal occult blood test every year, sigmoidoscopy every 5 years, or colonoscopy every 10 years.

The investigators found that even though colorectal cancer screening rates increased over the three-year period, there was evidence of ongoing under-utilization. In 2000, only 38 percent of patients reported that they had been screened with any test (23 percent reported screening by endoscopy [sigmoidoscopy or colonoscopy], and 22 percent reported screening by fecal occult blood test). In 2003, screening rates increased to 50 percent for any test (39 percent for endoscopy, and 24 percent for fecal occult blood test).

Individuals who reported that they had discussed colorectal cancer screening with their doctor were significantly more likely to be screened. Conversely, those who reported barriers to colorectal cancer screening, like concerns about cost or fears that cancer would be discovered, were less likely to be screened.

The authors concluded that the results “suggest that interventions focused solely on educating patients are not likely to increase rates significantly.” They noted that it is also important that “the provider and related health care system must be able to include discussions and recommendations for colorectal cancer screening in practice.”