Primary Care Research

Fewer than half of rural residents in Iowa are screened for colorectal cancer

With appropriate screening, colorectal cancer (CRC) can be largely prevented or caught and effectively treated in its early stages. Recommended guidelines suggest screening at certain intervals, depending on the specific test, beginning at age 50. Yet fewer than half (46 percent) of rural Iowa patients cared for by family physicians had up-to-date CRC screening, according to a new study. In addition, over half (62 percent) of these patients were tested because they had potential symptoms of CRC, such as anemia, blood in the stool, appetite change, abdominal pain, or weight loss.

Adequate discussion of CRC testing is complex, time consuming, and competes with other demands on the physician's time during office visits. Yet physician recommendations and how they present them to patients can greatly influence whether patients are tested, note the University of Iowa researchers. Among patients without symptoms of CRC who were screened, 90 percent recalled their physician recommending screening compared with 37 percent of those not up-to-date with CRC screening.

After excluding patients who had symptoms prior to screening, the chances of being tested in accordance with recommended guidelines doubled with government insurance compared with having other insurance, and more than doubled if patients had a health maintenance visit in the preceding 26 months. Having a family history of CRC, patient belief in the importance of CRC screening, patient satisfaction with doctor's discussions, and physicians trained in flexible sigmoidoscopy also significantly increased the likelihood that a patient would be screened for CRC. The findings were based on a study of 511 randomly selected rural patients aged 55 to 80 years who saw 16 board-certified Iowa family physicians in 2004. The researchers linked patient survey and medical record information to physician surveys to examine predictors of CRC testing. The study was supported in part by the Agency for Healthcare Research and Quality (HS14490 and HS13581).

More details are in "Colorectal cancer testing among patients cared for by Iowa family physicians," by Barcey T. Levy, Ph.D., M.D., Jeffrey Dawson, Sc.D., Arthur J. Hartz, M.D., Ph.D., and Paul A. James, M.D., in the September 2006 American Journal of Preventive Medicine 31(3), pp. 193-201.

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