How to prevent disparities in colon cancer screening

June 16, 2014, Group Health Research Institute

People living in poverty are less likely to be screened regularly for colorectal cancer—and more likely to develop the disease and die from it. How to end these disparities—and raise screening rates, lower disease rates, and prevent deaths? A promising way is to mail fecal immunochemical tests (a newer kind of stool test) to populations, Beverly B. Green, MD, MPH, and Gloria D. Coronado, PhD, wrote in the June 17 JAMA Internal Medicine.

Dr. Green is a Group Health physician and an associate investigator at Group Health Research Institute. Dr. Coronado is a senior investigator and the Mitch Greenlick endowed scientist for health disparities at Kaiser Permanente Center for Health Research, in Portland. The journal invited them to write a commentary about a study that David W. Baker, MD, MPH, of Northwestern University led and published in the same issue of the journal.

Drs. Green and Coronado applauded Baker's study for achieving repeat screening rates of more than 82 percent in a largely low-income community. But they were disappointed that only 60 percent of individuals with a positive screening completed follow-up diagnostic colonoscopy. "Lack of a follow-up colonoscopy defeats the purpose of a stool-test screening program," said Dr. Green, who is also an assistant clinical professor at the University of Washington School of Medicine.

Previous studies have shown that when low-income people get screening, they tend to prefer the option of doing a stool test in the privacy of their own home. But when the test is "positive" (detecting microscopic blood in the stool), people need to get a second test: a follow-up diagnostic colonoscopy. After a positive stool test, nearly a third of people have advanced pre-cancers that can be removed during the follow-up colonoscopy—and 4 percent have colorectal cancer.

"For many people, the barriers to receiving the needed follow-up diagnostic colonoscopy include cost," Dr. Green said. For instance, the Affordable Care Act (ACA) mandates full coverage of screening tests that the U.S. Preventive Services Task Force (USPSTF) recommends—with no out-of-pocket expenses. But it covers only the first test that a person chooses—a stool test, colonoscopy, or sigmoidoscopy—not any follow-up diagnostic testing. That's why Drs. Green and Coronado previously urged that the ACA be amended to cover co-pays for follow-up colonoscopies after a positive stool test or flexible sigmoidoscopy. Otherwise, people who choose those as their first tests could face high, unexpected costs from follow-up testing—and existing disparities in screening could worsen.

"On the other hand, most states' Medicaid insurance pays for both stool testing and follow-up colonoscopy, with no out-of-pocket patient costs," Dr. Coronado said. "So disparities in deaths from colorectal cancer could decrease rapidly in those states that have opted into Medicaid expansion."

Dr. Green previously showed in a randomized trial that doubled when Group Health's electronic health record was used in a new way to identify people who needed and give them stepped increases in support. And Drs. Green and Coronado showed it was feasible to use a population-based program for mailing stool tests to people in safety-net clinics.

Explore further: Mailing free tests to patients' homes boosts colon cancer screening rates

Related Stories

Mailing free tests to patients' homes boosts colon cancer screening rates

February 26, 2014
Colon cancer screening rates increased by nearly 40 percent when free stool tests were mailed to patients' homes, according to results of a pilot study published today in the journal BMC Cancer.

Simple, at-home test will detect most colorectal cancers

February 3, 2014
Tests that require patients to collect a single stool sample at home and then send it to a lab for analysis will detect about 79 percent of colorectal cancers, according to a new evidence review published in the Annals of ...

Outreach doubles colon cancer screening in low-income communities

June 16, 2014
In low-income and minority communities where colonoscopies may be prohibitively expensive for many residents, less-invasive, more frequent testing combined with automated reminders, can yield dramatic improvements in colorectal ...

Colonoscopy is indicated in unscreened elderly patients

June 3, 2014
(HealthDay)—Colorectal cancer (CRC) screening should be considered as a cost-effective strategy in unscreened patients older than 75 years, according to research published in the June 3 issue of the Annals of Internal Medicine.

Colon cancer screening doubles with new e-health record use

March 4, 2013
Researchers used electronic health records to identify Group Health patients who weren't screened regularly for cancer of the colon and rectum—and to encourage them to be screened. This centralized, automated approach doubled ...

Cheaper and easier isn't necessarily better in new colon cancer screening procedures

October 20, 2011
Eventually, colon cancers bleed and so tests for blood in stool seem an inexpensive and noninvasive alternative to traditional colonoscopies. In fact, a recent article in the journal Cancer Prevention Research showed that ...

Recommended for you

How cancer metastasis happens: Researchers reveal a key mechanism

January 18, 2018
Cancer metastasis, the migration of cells from a primary tumor to form distant tumors in the body, can be triggered by a chronic leakage of DNA within tumor cells, according to a team led by Weill Cornell Medicine and Memorial ...

Modular gene enhancer promotes leukemia and regulates effectiveness of chemotherapy

January 18, 2018
Every day, billions of new blood cells are generated in the bone marrow. The gene Myc is known to play an important role in this process, and is also known to play a role in cancer. Scientists from the German Cancer Research ...

These foods may up your odds for colon cancer

January 18, 2018
(HealthDay)—Chowing down on red meat, white bread and sugar-laden drinks might increase your long-term risk of colon cancer, a new study suggests.

The pill lowers ovarian cancer risk, even for smokers

January 18, 2018
(HealthDay)—It's known that use of the birth control pill is tied to lower odds for ovarian cancer, but new research shows the benefit extends to smokers or women who are obese.

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.