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New study implicates health care utilization, over biology, in colorectal cancer disparities
Date:4/6/2010

t to treat and has worse survival outcomes.

Participants in this study were part of the ongoing Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a multi-center, randomized, controlled screening trial designed to evaluate the effect of screening on cancer mortality. At the start of the colorectal cancer part of the study, participants were offered a screening flexible sigmoidoscopy, which is used to examine the lower, or sigmoid, portion of the colon. Subjects who had polyps or lesions detected during the sigmoidoscopy were referred to their personal physician for follow-up colonoscopy, the cost of which was not covered by the study.

In a colonoscopy, the entire colon, which is about five feet in length, is examined. During a sigmoidoscopy, only about the last two feet of the colon closest to the rectum is viewed. The records of the follow-up colonoscopies were collected and reviewed to determine which subjects had received them. Those results were analyzed to determine whether utilization of follow-up colonoscopy and likelihood of adenomas (pre-cancerous lesions) or colorectal cancer varied by race. In their analysis, to reduce the possibility that other factors were influencing the outcome of the study, the researchers documented age, education, sex, body mass index, smoking, family history of colorectal cancer, colon cancer screening within the previous three years, personal history of polyps, and center where the participant was screened.

Of the 60,572 study participants who received flexible sigmoidoscopy (57,561 whites and 3,011 blacks) at the start of the study, 23.9 percent of the white participants and 25.5 percent of the black participants had abnormal results, such as polyps or lesions. Among those with abnormal results, 72.4 percent of whites and 62.6 percent of blacks received a follow-up colonoscopy to determine whether cancer was present. The researchers found no statistically significant diff
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New study implicates health care utilization, over biology, in colorectal cancer disparities
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