Doctors fail to recommend colon cancer tests for low-income patients

Fewer than nine out of 10 low-income, medically underserved minority patients at risk for colorectal cancer receive a recommendation for colorectal cancer screening by physicians at government-supported community health centers, according to a study by Northwestern University researchers.

The researchers subsequently found that 7 percent of underserved minority patients at risk for developing colorectal cancer are appropriately screened.

The recommendation and screening rates determined in the study are the lowest to be reported in the medical literature among minorities and those of lower socioeconomic status.

The study, led by Northwestern researcher Michael Wolf, assistant professor of medicine, Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, was published in the February issue of the Journal of Health Care for the Poor and Underserved.

Wolf and colleagues wanted to determine the prevalence of physician recommendation and subsequent patient completion of colorectal screening tests receiving care at 31 inner-city Federally Qualified Health Centers in the United States, also known as community health centers. These are government-supported clinics that are required to provide services to patients regardless of insurance status.

The clinics are strategically located in areas designated as underserved by the U.S. Department of Health and Human Services. In urban areas such as Chicago, a large majority of the patients served by these clinics are from racial/ethnic minority groups - mostly African American or Hispanic individuals - and are living at or below the poverty level.

Underuse of recommended screening tests and/or delays in obtaining proper care among African American and Hispanic adults may contribute to higher incidence of advanced clinical stage cancer at presentation and to shorter five-year survival rates for colorectal cancer, the authors said.

Approximately 60 percent of the clinic patients are covered by Medicaid or a Medicaid managed care plan; another 25 percent are uninsured and pay for their care on a federally approved sliding fee scale; and 10 percent are covered by Medicare.

Underuse by these groups may be due in greater part to healthcare provider- or system-level barriers rather than characteristics of the individual patients.

"Organizational interventions are needed to support physicians in medically underserved areas and to promote recommended screening practices," the authors stated.

Wolf and colleagues found that three out of four patients who received a recommendation for colorectal cancer screening from their physician, completed the test.

"This underscores the importance of the physician's endorsement of screening," Wolf said.

Older patients are more likely than their younger counterparts to receive a recommendation and to be screened for colorectal cancer, the study also showed.

Data from the National Cancer Institute show that cancers of the colon and rectum are the fourth most commonly diagnosed cancers and rank second among cancer deaths in the United States.

Yet, despite evidence and recommendations supporting the need for colorectal cancer screening, only half of the 90 million Americans at risk (by age and/or family history) have been screened by any one of the appropriate methods, including periodic flexible sigmoidoscopy and/or annual Fecal Occult Blood Test, colonoscopy or air-contrast barium enema.