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

erences in the presence of adenomas, advanced adenomas, or cancer by race. It should be noted, however, that black participants were more likely to have cancer in the upper part of the colon, which would not be viewed during a sigmoidoscopy.

Overall, a total of 156 colorectal cancers were diagnosed among the participants who received a follow-up colonoscopy. Most of the cancers (75.6 percent) were stage I or II tumors, which are considered early stage disease. There was no statistically significant difference in the risk of colorectal cancer by race.

Among white participants, women and people with a family history of colorectal cancer were more likely than men or those without a family history to undergo a follow-up colonoscopy. Among black participants, those with a personal history of colon polyps were more likely to undergo follow-up colonoscopy than those without such a history.

The reasons behind the lower follow-up rates among black men and women in this study are unknown. It is possible that lower socioeconomic status may have affected health care utilization due to the direct and indirect costs of care, such as copays and lost wages. Although the authors did not have direct information on the socioeconomic status of study participants, the overall educational levelan indicator of socioeconomic statuswas lower in black participants than white participants. In addition, the need for multiple tests, including colonoscopy, following abnormal results of a screening sigmoidoscopy, and the cost and preparation required for those tests, could have deterred some people from receiving follow-up colonoscopies. Finally, a lack of knowledge about cancer prevention among patients and a lack of cultural competence on the part of the health care providers could be barriers to health care utilization.

When the authors analyzed the rate of follow-up colonoscopies by educational attainment, they observed differences at all educatio
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Source:Eurekalert  

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