Testing for colorectal cancer on the rise, but barriers to screening still exist

March 14, 2008

NEW YORK (Reuters Health) - The proportion of older adults undergoing screening for colorectal cancer increased overall from 2002 to 2006, according to data from the Centers for Disease Control and Prevention. However, disparities still exist, with low uptake particularly among racial minorities and individuals with no health insurance.

To evaluate changes in use of colorectal cancer tests, the CDC compared data from the 2002, 2004, and 2006 Behavioral Risk Factor Surveillance System surveys. Respondents age 50 years and older were asked if they had had a fecal occult blood test (FOBT) within 1 year and/or a lower endoscopy within 10 years preceding the survey.

The proportion of persons who reported having had either test within recommended intervals rose from 53.9% in 2002 to 56.8% in 2004 and 60.8% in 2006, Dr. D. A. Joseph and colleagues report in the Morbidity and Mortality Weekly Report for March 14. The increases were due primarily to higher rates of endoscopy, as rates of FOBT declined from 21.6% in 2002 to 16.2% in 2006.

Individuals age 65 and older were more likely to have been tested than younger subjects, which the authors attribute to Medicare coverage. Testing was more frequent among whites than among other races.

Rates of testing with either modality were highest in Connecticut (70.5%) and lowest in Mississippi (51.8%). According to the CDC, "Variations in prevalence of test use by state might result from variations in demographic characteristics, health insurance coverage, and availability of providers to perform endoscopy."

Factors associated with test rates below 50% in 2006 included Hispanic ethnicity, less than a high school education, annual household income less than $15,000, and lack of health insurance coverage.

"The coordinated efforts by CDC, state and local health departments, and the medical community to address barriers to and disparities in screening must be sustained so that the burden of (colorectal cancer) can be reduced in all persons," write the authors of an editorial note accompanying the report.