Primary Care Research

Both lack of patient awareness and physician counseling contribute to low rates of colon cancer screening

Colon cancer is the second leading cause of cancer deaths in the United States, yet national rates of colon screening are low. This low rate of screening appears to be due to lack of patient awareness and physician counseling rather than poor patient acceptance of screening, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS11683).

Christina C. Wee, M.D., M.P.H., and colleagues from Beth Israel Deaconess Medical Center and Harvard Medical School used data from the 2000 National Health Interview Survey (NHIS) of U.S. households to examine the prevalence of colon cancer screening nationally and the reasons for low screening rates. Among 11,427 respondents to the NHIS Cancer Control Supplement, 16 percent reported annual fecal occult blood testing (FOBT) and 29 percent reported having undergone a sigmoidoscopy in the last 5 years or a colonoscopy in the last 10 years. After adjusting for age, sex, body mass index, health care access, and region of the country, Hispanics were 30 percent less likely to undergo FOBT and 20 percent less likely to undergo sigmoidoscopy or colonoscopy compared with whites. People with lower educational levels were also less likely to undergo screening.

Neither race nor education had any bearing on whether patients followed physician recommendations for colon cancer screening. However, Hispanics and those with lower educational levels were less likely to receive counseling from their health provider about screening.

Among the 9,017 respondents who did not undergo FOBT, 64 percent were unaware they needed the test. Of those who had a provider visit in the previous year, 94 percent were not counseled by their doctor about the test. Less than 1 percent cited discomfort or cost as a deterrent.

Among the 7,863 respondents who did not undergo sigmoidoscopy or colonoscopy, 72 percent were unaware that they needed the procedure. Of these respondents, 5,096 had a provider visit within the past year and 92 percent were not counseled by their doctor about the procedure. Only 2 percent were deterred by discomfort or cost.

More details are in "Factors associated with colon cancer screening: The role of patient factors and physician counseling," by Dr. Wee, Ellen P. McCarthy, Ph.D., M.P.H., and Russell S. Phillips, M.D., in Preventive Medicine 41, p. 23-29, 2005.

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