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Colon cancer screening in the ambulatory setting
Judith M E Walsh1, Samuel F Posner, Eliseo J Perez-Stable
1Division of General Internal Medicine, University of California San Francisco, Box 1732, 1701 Divisadero, San Francisco, CA 94115, USA. jwalsh@medicine.ucsf.edu
Preventive Medicine
|August 31, 2002
Summary
Colon cancer screening rates are low, particularly in younger, less frequently seen, uninsured, or non-managed care patients. Factors like age, ethnicity, insurance, and clinician type influence screening uptake.
Area of Science:
- Oncology
- Preventive Medicine
- Health Services Research
Background:
- Despite proven mortality reduction, physician implementation of colon cancer screening recommendations remains suboptimal.
- Understanding patient and clinician factors is crucial for improving screening adherence.
Purpose of the Study:
- To identify patient and clinician-associated factors influencing colon cancer screening rates.
- To analyze predictors for fecal occult blood testing and sigmoidoscopy.
Main Methods:
- Retrospective review of computerized medical records from primary care practices.
- Analysis of 6,039 patients aged 50-74 between July 1995 and June 1997.
- Inclusion of fecal occult blood testing, sigmoidoscopy, and colonoscopy data.
Main Results:
- Only 53% of patients underwent any form of colon cancer screening; fecal occult blood testing in 44%, sigmoidoscopy in 26%.
- Patient factors associated with screening included age, Asian ethnicity, visit frequency, recency of last visit, and insurance type.
- Clinician type (nurse practitioners, residents) was associated with lower screening rates compared to physicians and faculty.
Conclusions:
- Colon cancer screening rates are low in primary care, with disparities observed in younger, less frequently seen, uninsured, or non-managed care populations.
- Further research is needed to address these disparities and enhance screening across all patient groups, particularly the underscreened.
- Targeted interventions are essential to improve adherence to colon cancer screening guidelines.