Even when Americans have health care 'safety net' in place, rates barely budge, report finds
TUESDAY, Sept. 8 (HealthDay News) -- Despite highly publicized education campaigns and widespread agreement about the importance of colorectal cancer screening, only 61 percent of Americans who should be screened do so, new research finds.
Rates for minorities, the uninsured and other vulnerable groups are lower still, with only 22 percent of lower-income people served by a "safety net" health system in Texas being screened.
Using data from a health system in Tarant county, Tex., researchers identified 20,416 men and women ages 54 to 75 who were eligible for colorectal cancer screening.
The Tarrant County Hospital District, which includes Forth Worth, Texas, is a safety net health system that serves 155,000 individuals a year, many of them uninsured or Medicaid recipients.
About 15 percent of the patients lived below the poverty line. The median household income was $35,419. Most patients were either black or Hispanic; nearly 20 percent reported a primary language other than English.
Patients most likely to get screened included those who saw a doctor regularly or who had health insurance, said Dr. Samir Gupta, assistant professor in the department of internal medicine at the University of Texas Southwestern Medical Center.
"Once you controlled for those variables, the screening rate was essentially zero," Gupta said.
About 40 percent of those in the study had health insurance, including Medicare and Medicaid, while another 40 percent had medical coverage through their connection to the safety net system. Twenty percent were uninsured.
Those with insurance were almost three times as likely to be screened, and those who saw the doctor regularly were nearly four times as likely to be screened.
Women were slightly more likely than men to be screened. Hispanics were slightly more likely to be screened than whites.
The study appears in the September issue of Cancer Epidemiology, Biomarkers & Prevention.
Karen Glanz, a professor of medicine and nursing at the University of Pennsylvania and an editorial board member of Cancer Epidemiology, Biomarkers & Prevention, said the study documents some of the barriers to colorectal cancer screening.
"The idea that colorectal cancer screening rates are too low is not a new idea, but this is one of the first to document it in a specific population," Glanz said. "Access to care clearly has consequences, and any talk of health care reform needs to address proven prevention measures like screening."
Low-income, uninsured women have access to other screenings through the U.S. Centers for Disease Control's National Breast and Cervical Cancer Early Detection Program.
While good for breast and cervical cancer screening efforts, many other types of cancers don't benefit from such a comprehensive screening approach.
"Theoretically, the same model could be applied to colorectal cancer, but do we want to keep passing legislation for programs that target specific types of cancer, or could we provide more broad access to health care so we can make a serious and coordinated effort at prevention?" Gupta said. "That's the question that needs answering."
Colorectal cancer, which kills nearly 50,000 Americans a year, is the second leading cause of cancer death in the United States after lung cancer. There are several types of screening tests available.
The National Cancer Institute has more on colorectal cancer screening.
-- Jennifer Thomas
SOURCE: Cancer Epidemology, Biomarkers & Prevention, news release, Sept. 8, 2009
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