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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. r. 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
The investigators found that even though
colorectal cancer screening rates increased
over the three-year period, there was
evidence of ongoing under-utilization.
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.”
Article: “Predictors of Colorectal Cancer
Screening From Patients Enrolled in a
Managed Care Health Plan.” Melissa M.
Farmer, Roshan Bastani, Lorna Kwan, Michael
Belman, and Patricia A. Ganz. CANCER;
Published Online: February 11, 2008 (DOI:
10.1002/cncr.23290); Print Issue Date: March