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No insurance? No colonoscopy

John M Inadomi highlights the disparity in colorectal cancer screening (CRCS) among different socioeconomic and ethnic groups in US society in a recent review published by F1000 Medicine Reports (

Colorectal cancer is the second leading cause of cancer-related death in the developed world. In this report, John Inadomi, chief of Clinical Gastroenterology at the San Francisco General Hospital and a frequent contributor to F1000 Medicine, writes that the uptake of certain types of screening has been linked to inadequate medical insurance amongst the poorer socio-economic and ethnic groups.

Of the several screening modalities currently available, colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT) have been shown to reduce colorectal cancer incidence or mortality. Inadomi draws attention to the high prevalence of 'flat' colonic lesions since some screening methods are less likely to detect flat lesions, patients who opt for these modalities (e.g. for financial reasons) could be at risk of lesions being missed.

One study cited in Inadomi's report found that "African-American women were half as likely as white women to report having undergone screening by colonoscopy." Added to this, awareness of the different tests for CRCS was significantly lower among African-Americans than whites. Correspondingly, there was a similar significant difference in lack of medical insurance coverage between these groups.

New technologies used in rural primary care practice to educate people to different types of CRCS have proven to raise the number of patient intention to get screened, helping to overcome socio-economic barriers.

While recognising that language, culture and economic inequality remain significant barriers, Inadomi is optimistic about "the use of new technology and techniques for disseminating information among patients and their providers", and concludes that the efficacy of CRCS may be better improved by "specific educational interventions" than by any given advance in current screening technologies.


Contact: Kathleen Wets
Faculty of 1000: Biology and Medicine

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