A Population-Based Study of Colorectal Cancer Test Use. Results from the 2001 California Health Interview Survey

Department of Surgery, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA.
Cancer (Impact Factor: 4.89). 01/2005; 101(11):2523-32. DOI: 10.1002/cncr.20692
Source: PubMed


Recent research has supported the use of colorectal cancer (CRC) tests to reduce disease incidence, morbidity, and mortality. A new health survey has provided an opportunity to examine the use of these tests in California's ethnically diverse population. The authors used the 2001 California Health Interview Survey (CHIS 2001) to evaluate 1) rates of CRC test use, 2) predictors of the receipt of tests, and 3) reasons for nonuse of CRC tests.
The CHIS 2001 is a random-digit dial telephone survey that was conducted in California. Responses were analyzed from 22,343 adults age >/= 50 years. CRC test use was defined as receipt of a fecal occult blood test in the past year and/or receipt of an endoscopic examination in the past 5 years.
Nearly 54% of California adults reported receipt of a recent CRC test. Insurance coverage and having a usual source of care were the most important predictors of CRC testing. Latinos age < 65 years were less likely to be tested than whites (relative risk [RR], 0.84; 95% confidence interval [95% CI], 0.77-0.92). Men were more likely to be tested than women, an effect that was greater among individuals age 50-64 years (RR, 1.28; 95% CI, 1.23-1.32) than among individuals age >/= 65 years (RR, 1.19; 95% CI, 1.15-1.23). Women were more likely than men to say that their physician did not inform them the test was needed and that CRC tests were painful or embarrassing.
Results of the current study indicate a need for physicians to recommend CRC testing to their patients. Assuring that all individuals have both health insurance and a usual source of care would help address gaps in the receipt of CRC tests.

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Available from: Nancy Breen, Feb 02, 2015
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    • "CRC is highly treatable with early detection, which can significantly reduce morbidity and mortality. Yet, Asian Americans have some of the lowest CRC screening rates in the United States (Etzioni et al., 2004; Wong, Gildengorin, Nguyen, & Mock, 2005). CRC screening places particularly high demands on individuals, including scheduling beyond a regular doctors' appointment, independent test preparation, and/or complex completion instructions (Arnold et al., 2012; Vernon & Meissner, 2008). "
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    ABSTRACT: The authors examined the relationship between low health literacy (LHL), limited English proficiency (LEP), and meeting current U.S. Preventive Service Task Force colorectal cancer (CRC) screening guidelines for Asians and Whites in California. For 1,478 Asian and 14,410 White respondents 50-75 years of age in the 2007 California Health Interview Survey, the authors examined meeting CRC screening guidelines using multivariable logistic models by LEP and LHL separately and in combination. Analyses were run with the full sample, then separately for Whites and Asians controlling for demographics and insurance. For those with LEP, patient-provider language concordance and CRC screening was examined. Overall, respondents with LEP and LHL were the least likely to meet CRC screening guidelines (36%) followed by LEP-only (45%), LHL-only (51%), and those with neither LHL nor LEP (59%), a hierarchy that remained significant in multivariable models. For Whites, LHL-only was associated with screening, whereas LEP-only and LEP and LHL were significant for Asians. Having a language concordant provider was not significantly associated with CRC screening among those with LEP. Health literacy is associated with CRC screening, but English proficiency is also critical to consider. Asians with both LEP and LHL appear particularly vulnerable to cancer screening disparities.
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    • "In our study, Latino women were more likely to be up-to-date with screening than were men, although in the California Health Interview survey, a community-based survey of a diverse population of participants, men were more likely to be tested than women [17]. It may be that women who are seen in primary care clinic settings are more used to undergoing regular screening tests such as mammography and Pap smears and hence also receive FOBT. "
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    • "But the best case scenario, estimated from survey data, is that 23% of the screen-eligible population has ever been screened [8] and that 53% of Canadian physicians have undergone CRC screening [13]. These physician rates are comparable to rates for the CRC screen-eligible population in the U.S., which range between 38% and 54% [14,15]. Yet there are methodological challenges to estimating population CRC screening rates. "
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