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Expanding colorectal cancer screening among minority women.

ABSTRACT: Colorectal cancer screening (CRCS) in the United States is inadequate in minority communities and particularly among those who lack insurance. Finding ways to increase screenings in these minorities presents a healthcare challenge. The authors sought to determine whether offering CRCS at the time of mammography is an effective way to increase CRCS among minority women.This study was offered to women attending the Breast Examination Center of Harlem (BECH), a community outreach program of Memorial Sloan-Kettering serving the primarily black and Hispanic Harlem Community. Screening was explained, medical fitness was determined, and colonoscopies were performed. Barriers to screening and ways to overcome them were ascertained. Participants had to be at least 50 years of age without a history of colorectal cancer or screening within the last 10 years.There were 2616 women eligible for CRCS, of these women 2005 (77%) refused to participate in the study, and 611 (23%) women were enrolled. There was a high interest in CRCS including among those who declined to participate in the study. The major barrier was lack of medical insurance, which was partially overcome by alternative funding. Of the 611 women enrolled, 337 (55%) went on to have screening colonoscopy. Forty-nine (15%) women had adenomatous polyps.Offering CRCS to minority women at the time of mammography and without a physician's referral is an effective way to expand screening. Screening colonoscopy findings are similar to those in the general population. Alternatives to traditional medical insurance are needed for the uninsured.

SUBMITTER: Shike M

PROVIDER: S-EPMC3782747 | biostudies-literature | 2011 Jan

REPOSITORIES: biostudies-literature

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Expanding colorectal cancer screening among minority women.

Shike Moshe M Schattner Mark M Genao Alvaro A Grant Winsome W Burke Margaret M Zauber Ann A Russo Lianne L Cuyjet Valerie V

Cancer 20101025 1

<h4>Background</h4>Colorectal cancer screening (CRCS) in the United States is inadequate in minority communities and particularly among those who lack insurance. Finding ways to increase screenings in these minorities presents a healthcare challenge. The authors sought to determine whether offering CRCS at the time of mammography is an effective way to increase CRCS among minority women.<h4>Methods</h4>This study was offered to women attending the Breast Examination Center of Harlem (BECH), a co ...[more]

PMID: 21170901

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Project description:Background/AimsSince 1993, the US Preventive Services Task Force has recommended screening to prevent colorectal cancer among average risk adults, beginning at age 50. Many studies over the past 20 years evaluated factors associated with screening uptake; however, few have focused on individuals who are newly eligible (i.e., those turning 50 years). We evaluated patient characteristics associated with uptake and time to initiation of colorectal cancer tests in a population newly-eligible for screening.MethodsThe study included 128,358 individuals who were members of an integrated care delivery system (Group Health) and enrolled on their 50th birthday from 1996–2011. We assessed receipt of colorectal cancer tests within 5 years of eligibility, and calculated the median time to first test. We examined patient characteristics associated with use of colorectal cancer tests overall using Cox proportional hazards models.ResultsStool-based tests were most commonly used, with uptake ranging from 35–40% of the cohort across the study period. The proportion of individuals initiating colorectal cancer testing via colonoscopy increased from 3% in members becoming eligible in 1996–1998 to 21% in 2005–2007. Time to first test varied across test types. Median time to the first test was 3 months shorter in members who chose stool-based tests (25.2 months) compared to those who chose colonoscopy (28.2 months) among members newly eligible in 2005–2007. However, we observed no temporal changes in median time to first test, conditional on test type. Characteristics associated with increased uptake included more recent enrollment at age 50 (e.g., 2008–2010:HR = 2.16, 95% CI 2.09–2.23) and Asian background (HR = 1.08, 95% CI 1.05–1.11). Factors associated with reduced uptake included being a woman (HR = 0.93, 95% CI 0.91–0.94), African-American (HR = 0.95, 95% CI 0.91–0.99) or Pacific Islander (HR = 0.86, 95% CI 0.76–0.96), diagnosed with diabetes (HR = 0.88, 95% CI 0.85–0.91) and being moderately or severely obese (HR = 0.83, 95% CI 0.81–0.85 and HR = 0.75, 95% CI 0.73–0.77, respectively).ConclusionsPatient characteristics associated with initiation of colorectal cancer testing in a newly eligible population are similar to previous findings among all-age eligible adults. Further, while the time to the first test remained stable, there was an increase in colorectal cancer testing during the study period.

Project description:IntroductionColorectal cancer screening program compliance in Turkey is around 20-30%. Factors that may affect preventive health behavior, mainly individuals' values, beliefs and attitudes, should be explored. A "Health Belief Model" (HBM) scale was developed in 1950 to explain the insufficient participation of some individuals in screening programs. The scale was adopted for colon cancer in 2002. The validity and reliability study of this scale for the Turkish language was conducted in 2007. In this study we aim to evaluate the health beliefs of relatively young individuals before the age of screening in relation to attitudes to colorectal cancer screening via the Turkish version of the scale.Materials and methodsA questionnaire composed of 14 sociodemographic questions and 33 HBM scale questions were applied to the patients of a Family Medicine outpatient clinic where the majority of the patients are relatively young people. The data was analyzed using the IBM SPSS version 21.0.ResultsA total of 310 subjects at the age of 18 and over were informed about the study. The study was completed with 215 subjects with a participation rate of 69.3%. The average age of the participants was 35.4 ± 12.8 years; 62.8% of them were women; 26.0% were students. 94.4% of the participants did not have a history of colon cancer among their first degree relatives. 58.1% agreed that "A colonoscopy should be done every ten years starting at age 50 to screen for colon cancer." Age, marital status, education and occupation status were found to have an effect on barrier scores. Young participants, singles, and those with a primary and/or secondary school education had statistically significant higher barrier scores. The motivation scores of high school graduates were higher than university graduates. The seriousness scores of men were found to be higher than women.ConclusionOur study points out that attitudes about preventive health measures are mainly associated with age, gender, education level and marital status. These personal characteristics should be taken into consideration while offering screening programs and preventive health measures to individuals in order to protect against colorectal cancer. It is better to give specific messages according to personal characteristics and specific barriers instead of general messages about conducting screening tests beginning from a young age.

Project description:INTRODUCTION:Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients. METHODS:This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests. RESULTS:One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter. CONCLUSIONS:Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.

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Expanding colorectal cancer screening among minority women.

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Expanding colorectal cancer screening among minority women.

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