Low colon cancer screening rates leaves a million New Yorkers at risk

Half of New York City residents over 50, the age at which the American Cancer Society recommends beginning screening tests, have not received a colon cancer-screening test within the recommended time intervals, according to a new study. The report, published in the September 1, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, says those New Yorkers least likely to have received screening include those with low-income, the uninsured, Asians and current smokers.

More than 56,000 Americans are expected to die this year from colorectal cancer, making it the third leading cause of cancer death in both men and women. Screening tests, which include the fecal occult blood test (FOBT), flexible sigmoidoscopy (FS), and colonoscopy, have been proven to reduce mortality and be more cost-effective than breast cancer screening tests, which are more widely used. Current screening guidelines recommend annual FOBT, FS every 5 years, or a colonoscopy every 10 years, but only 53 percent of Americans receive timely screening.

New York City is unique in that there is high density of gastroenterologists and endoscopy labs to provide access to colonoscopy services. In 2003, the city adopted new screening guidelines–a colonoscopy every 10 years or FOBT every year as an acceptable, although not optimal, alternative for those unwilling or unable to undergo colonoscopy. To evaluate the effect of this change, Lorna Thorpe, Ph.D. of the New York City Department of Health and Mental Hygiene and researchers from leading hospitals and academic institutions conducted a baseline telephone survey of the colon cancer screening habits of 9,802 New York City residents.

Only 55 percent of the 3606 New York City adults age 50 and older reported a recent colorectal cancer screening test within the time interval recommended by national guidelines. Forty-two percent of those received a colonoscopy, while 32 percent received a FOBT and 10 percent received FS, respectively.

Analysis showed that men were more likely than women to have received either colonoscopy or FS. Also, men age 65 and older were significantly more likely to have a colonoscopy than younger men. Non-Hispanic African-Americans and women were less likely to receive colonoscopies, having higher rates of FOBT use instead. The lower uptake of colonoscopy among non-Hispanic African-Americans was of particular concern, given the high rates of colon cancer mortality in this population in New York City. Asians–women in particular–were the racial group least likely to have undergone a timely screening test. In addition, smoking, low-income and lack of health insurance were each associated with a decreased likelihood of having had a recent screening test. In contrast, those who utilized preventive care, such as receiving annual flu shots, were more likely to have a screening test within the recommended time interval.

Dr. Thorpe and her colleagues conclude, “nearly half of New Yorkers ages 50 and older are not undergoing screening within the recommended schedule.” They add, “Resources and interventions designed to increase screening practices, particularly colonoscopy, will need to target poor and uninsured communities.”