Lack of colorectal cancer screening exists in safety-net health care system

Less than 25% of potential screen-eligible people within a safety-net health care system had been screened for colorectal cancer, according to the results of a study conducted in Tarrant County, Texas. Access to care, defined as having health insurance or more than two outpatient visits within a year, was an independent predictor of whether or not individuals had completed colorectal cancer screening.

In a retrospective study, researchers examined data from 20,416 individuals aged 54 to 75 years from The Tarrant County Hospital District John Peter Smith Hospital Health Network.

Twenty-two percent of individuals had been screened for colorectal cancer. In a univariate analysis, screening completion was higher among women, individuals aged 65 to 75 years, blacks, Hispanics, primary Spanish language speakers, individuals seen as outpatients more than two times and the insured. In multiple logistic regression analysis, only sex, age 65 to 75 years, Hispanic ethnicity, more than two outpatient visits and insurance status remained independent predictors of screening.

Insurance and access to care were the most strongly associated with the completion of screening: adjusted odds ratios at 2.57 (95% CI, 2.23-2.98) for any insurance and 3.53 (95% CI, 3.15-3.97) for more than two outpatient visits. There was also a trend between increasing screening completion with increasing years of insurance coverage (P<.001), according to researchers. Among those who completed screening, 87% had a record of insurance and more than two outpatient visits.

“Of our patients who did get screened, they either had insurance or saw their doctor regularly; once you controlled for those variables, the screening rate was essentially zero,” Samir Gupta, MD, assistant professor at the University of Texas Southwestern Medical Center, in Dallas, said in a press release.

Gupta A. Cancer Epidemiol Biomarkers Prev. 2009;18:2373-239.