|New Study Implicates Healthcare Utilization Rates, More than Biology, in Colorectal Cancer Disparities|
Higher rates of colorectal cancer incidence and mortality experienced by African-Americans may be driven largely by differences in health care utilization, and less by biology, according to a new study led by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health.
Goers: In a study involving more than 60,000 people who were screened for colorectal cancer, researchers found that blacks and whites were equally likely to need follow-up after a screening, but blacks were less likely to actually receive it.
Dr. Laieymo: It has long been documented that blacks in the United States they have a higher incidence of colorectal cancer and they also have a mortality, that is death, from colorectal cancer.
Goers: Dr. Adeyinka Laiyemo is a researcher with the National Cancer Institute and a faculty member at Howard University. He says studies have shown that for blacks, colon cancer is more likely to be diagnosed at later stages.
Dr. Laieymo: And since screening by itself is generally not covered if you do not have insurance, it has long been debated all the higher incidents and mortality from colorectal cancer that is seen in blacks is it because they donít have access and probably do not utilize access even if they have it to health care resources or is it because they have a different susceptibility to colon cancers.
Goers: The participants in this study were part of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or PLCO, a multi-center, randomized, controlled screening trial designed to evaluate the effect of screening on cancer mortality funded by the NCI. Dr. Laieymo explains that there are about 150,000 people in the PLCO trial, half of them randomized to have some screening.
Dr. Laieymo: One of the screening tests that was done at baseline for these participants was what you would call flexible sigmoidoscopy. Flexible sigmoidoscopy is a screening test for colon cancer in which a short video camera is used to look in the initial part of the colon from below. Now if any polyp was found in this trial, the patient is referred to his or her doctor so that they can get follow-up which generally should be a full colonoscopy to take a look in the entire colon. Now PLCO covered the cost of the flexible sigmoidoscopy screening, but the follow-up for it if an abnormality is found was not covered by PLCO which means the individual and their physician they have the task of going ahead and following up on those abnormal results.
Goers: Researchers realized that roughly 25% of both groups had abnormal polyps. Dr. Laieymo adds that the PLCO continued to contact these participants in the trial on a regular basis to ensure that they received necessary follow-up, and every follow-up was expected to be conducted within one year.
Dr. Laieymo: However, what we realized was after one year from that deadline in this trial, only about 72 percent of whites that had abnormal findings went on to have a colonoscopy, but only that was 62 percent of blacks. However, when we now collected the results of their colonoscopy performed on what was found we did not see any significant differences. Our study making us believe that this is probably more because they do not have equal access to care or they are not utilizing access to care.
Goers: NCI scientists say this research suggests that targeting interventions toward increasing the use of screening among minority populations might go a long way toward reducing disparities in colorectal cancer. For more information on colon screenings, visit the NCI home page at www.cancer.gov and search "colorectal cancer." This is Elizabeth Goers, National Institutes of Health, Bethesda, Maryland.