Geography a factor in colorectal screening rates

The disparities seen in colorectal cancer screening rates appear to be linked not only to racial/ethnic factors but also geography, according to a study of screening status among Medicare enrollees.

Thomas J. Semrad, MD, and a team from the University of California – Davis Cancer Center describe their findings regarding colorectal screening status among Medicare patients as of December 31, 2003 (Cancer; published online ahead of print). They analyzed data from 53,990 persons, aged 69 to 79 years, in eight states and 11 regions, including: Atlanta, rural Georgia, San Francisco-Oakland, San Jose-Monterey, Los Angeles County, Seattle-Puget Sound (Washington), Detroit, Connecticut, Hawaii, Iowa, and New Mexico. An “up-to-date” status was defined as having had fecal occult blood testing in the prior year or sigmoidoscopy or colonoscopy in the prior five years. 

Dr. Semrad and colleagues found that whites were more likely to be up-to-date in their colorectal cancer screening than members of other races/ethnic groups anywhere other than Hawaii: In what Dr. Semrad called a “stunning” finding in a statement detailing the study results, Hawaii's Asian-Pacific Islanders had significantly higher screening rates than whites (52% vs. 38%). In Michigan, San Francisco, Los Angeles, and San Jose, however, up-to-date-screening prevalence was significantly lower among Asian-Pacific Islanders than among whites. Dr. Semrad noted that the high up-to-date status in Hawaii might be attributable to the influence of Japanese culture in that state, as other gastrointestinal cancers are prevalent among the Japanese and there may be more awareness of the benefits of screening.

Overall, white vs. nonwhite up-to-date status varied significantly across regions for blacks and Asian-Pacific Islanders, but not for Hispanics. The biggest differences in whites vs. blacks in terms of proportion up-to-date were seen in Atlanta, rural Georgia, and the San Francisco Bay area of California, where more whites were up to date than blacks. But no significant differences existed between whites and blacks in Connecticut, Seattle, or Iowa.

Little geographic variation in up-to-date status among whites was noted.           

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