High out-of-pocket costs, lack of health insurance and limited access to care contribute to a relatively low rate of colorectal cancer screening in the United States, according to a new systematic review by researchers at the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.

The research, published in the April 13 issue of Annals of Internal Medicine and funded by the Agency for Healthcare Research and Quality, consisted of a systematic review of more than 100 studies concerning the use and quality of appropriate colorectal cancer screening conducted in the United States between 1998 and 2009.

The research showed that low household income, lack of health insurance, limited access to care, and not being informed by a physician or health-care provider of the need for colorectal cancer screening were among the major reasons people did not get screened.

"Colorectal cancer screening is used much less than other types of cancer screening, such as for breast and cervical cancer screening," said Debra Holden, PhD, senior director of RTI’s Community Health Promotion Research Program and the paper’s lead author. "We found that access to care isn’t the only issue. After patients have access to care, they need a simple and reliable mechanism by which to interact with their physicians and others in the health-care system to understand the need for screening and the pros and cons of each type of screening strategy."

The research showed that one of the best ways to increase appropriate colorectal cancer screening is for doctors and nurses to have one-on-one discussions with their patients about the potential benefits and risks as well as the process for obtaining the screening.
The results also found that physician’s offices that improved systems for referring patients for screening and designated someone to help patients navigate the health-care system increased colorectal cancer screening rates.

Sending reminders to patients also led to small or moderate increases in colorectal cancer screening.

The researchers noted that although underuse of colorectal screenings is a key worrisome finding, the results also found evidence that colorectal screening tests are overused and misused.

"We also found that there are times when people are being screened who should not be screened, polyps are being removed that should not be removed, and screenings are conducted poorly. Yet very little research is currently directed at these problems. We need to adjust our research priorities," said Russell Harris, MD, a UNC professor and co-principal investigator of the project. Harris is professor of medicine in the UNC School of Medicine, adjunct professor of epidemiology in the UNC Gillings School of Global Public Health, and a member of the UNC Cecil G. Sheps Center for Health Services Research and the UNC Lineberger Comprehensive Cancer Center.

The evidence review was conducted by AHRQ’s RTI-UNC Evidence-based Practice Center, a collaboration between RTI and the five health professions schools and the UNC Cecil G. Sheps Center for Health Services Research. The study is available online.
Source: RTI International