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Disparities in Colorectal Cancer Screening

Is the use of colorectal cancer screening equitable in the U.S.?

Colorectal cancer screening rates overall remain relatively low in the U.S. and are particularly low in certain subgroups. To identify potential disparities in screening, investigators evaluated data from 596,470 Medicare beneficiaries in New York, Florida, and Illinois. All study participants were at average risk for colorectal cancer (i.e., no history of colon polyps, colon cancer, or inflammatory bowel disease). Study participants were categorized as having high, medium, or low income and education levels based on their postal codes.

During 2002 and 2003, 18% of the study population underwent colorectal cancer screening. However, rates varied substantially by demographics. Nonwhites were much less likely than whites to be screened for colorectal cancer (relative risk, 0.52; 95% CI, 0.50–0.53). Among whites, women were significantly less likely than men to undergo screening. Although this gender gap was observed in all income and age categories, it was greatest among those aged 80 or older with middle or high income levels (RR, approximately 0.60). Higher income levels were significantly associated with screening colonoscopy only in white participants (RRs, 1.19 for men and 1.09 for women). The likelihood of screening was also significantly greater among people with middle or high education levels (RR, 1.33 and 1.52, respectively) than among those with low education levels.

Comment: These data support the need for special efforts to promote screening in ethnic minority populations and in people with less formal education.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology April 20, 2007

Citation(s):

Ananthakrishnan AN et al. Disparities in colon cancer screening in the Medicare population. Arch Intern Med 2007 Feb 12; 167:258-64.

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• Medline abstract (Free)