Observational Study Finds Disparity in Screening for Colorectal Cancer

Being blind, intellectually disabled, or having a spinal cord injury can reduce the probability of a person being screened for colorectal cancer (CRC). These were the findings of an observational study conducted by researchers at the University of Missouri.

CRC is the fourth most common type of cancer in the United States and led to 50,000 deaths in 2016 alone. While a combination of screening and improved treatments have brought a reduction in the death rate, there’s room for improvement. Available screening tests for CRC include:

• Colonoscopy
• Flexible sigmoidoscopy
• Computed tomography colonography
• Guaiac-based fecal occult blood test
• Fecal immunochemical test
• Multitargeted stool DNA test
• Methylated SEPT9 DNA test

The US Preventive Services Task Force (USPSTF) revised its screening guidelines for CRC last year. The new guidance recommends screening for CRC for those 50 to 75 years of age (A recommendation), and leaves the decision for screening in those 76 to 85 years of age on the individual, after considering the patient’s overall health and screening history (C recommendation). However, for the 50 to 75 age group, the USPSTF leaves the choice of the test on the individual, which is a departure from the previous guideline.

In their current study, published in the American Journal of Preventive Medicine the authors evaluated CRC screening over a 10-year period between 2000 and 2009, extracting data from South Carolina Medicaid and Medicare, State Health Plan, and hospital discharge data. The primary objective was to evaluate whether adults, aged 50-75 years, with 1 of 3 disabilities (blind/low vision [BLV], intellectual disability [ID], or spinal cord injury [SCI]) receive CRC screening at rates equivalent to normal adults.

The analysis found that adherence to changing CRC screening recommendations was low among those who had ID (34.32%) or SCI (44.14%), compared with those without the disabilities (48.48%).

“When studying adherence rates to recommended screenings, we found that individuals with blindness or low vision, an intellectual disability or a spinal cord injury are less likely to receive screenings than those without these disabilities,” said study author Chelsea Deroche, PhD, assistant professor of biostatistics in the MU Department of Health Management and Informatics and in the Biostatistics and Research Design Unit.

Deroche believes that lack of education and awareness, transportation challenges, or some other barriers could explain the lack of routine screening among these individuals. “These findings support the need for increased awareness and targeted advocacy outreach efforts to both physicians and caregivers to ensure all individuals are screened appropriately,” she added.