Monday, August 29, 2016

Who isn't receiving colorectal cancer screening?

- Jennifer Middleton, MD, MPH

The U.S. Preventive Services Task Force recently updated its colorectal cancer screening recommendations, affirming its prior “A” grade for adults aged 50 to 75. While screening rates in the U.S. have increased over the past decade, there is still room for improvement, especially among uninsured individuals, some minority populations, and immigrants. A 2010 systematic review found lower rates of colorectal cancer screening among Hispanic and Asian Americans, along with anyone born outside of the United States. A more recent study found even lower rates among Spanish-speaking Hispanics compared to English-speaking Hispanics. Differences in access to care only accounted for some of these disparities.

Successful strategies that increase screening rates include providing fecal occult blood tests in a manner that addresses language barriers, and providing culturally appropriate patient education materials and/or 1-on-1 contact with a nurse or health educator. Additionally, the state of Michigan partnered with a large health insurer to mail reminder cards about colorectal cancer screening, which increased uptake by 16%; in Wisconsin, providing grants for screening events in underserved communities also increased screening rates. Adding a telephone call to a reminder letter increased screening rates in New York, but telephone calls by themselves did not. Ensuring adequate physician access for minority and underserved populations also increases screening; one study found that the distribution and supply of family physicians and gastroenterologists correlates with better screening rates.

Although many practices track their overall colorectal cancer screening rates, this figure may mask variations by race, ethnicity, or foreign-born status. Recognizing screening disparities is an important first step. Trying one or more of the above interventions to improve screening rates in underserved populations with a Plan, Do, Study, Act (PDSA) cycle might then be a reasonable next course of action. There’s a recent AFP article on Colorectal Cancer Screening and Surveillance if you’d like a refresher on recommended screening methods.