Reports call for interventions to reduce screening underuse; studies to reduce overuse, misuse
WEDNESDAY, April 14 (HealthDay News) -- Colorectal cancer screening rates fall short of desirable levels, according to two early-release articles published online April 13 in the Annals of Internal Medicine. One article urges targeted initiatives to improve screening rates and reduce disparities in underscreened communities and population subgroups. The other article confirms that important problems exist regarding the underuse, overuse and misuse of screening, and also urges system- and policy-level interventions.
In the first article, a National Institutes of Health state-of-the-science conference statement, Donald Steinwachs, Ph.D., of Johns Hopkins University in Baltimore, and colleagues cite statistics showing that overall screening rates for adults ages 50 and older have increased from 20 to 30 percent in 1997 to nearly 55 percent in 2008, but that blacks, Hispanics, and immigrants are significantly less likely to be screened than non-Hispanic whites. To close the gap, the report identifies six priority areas for implementation and research, including the elimination of financial barriers to colorectal cancer screening and appropriate follow-up.
In the second article, Debra J. Holden, Ph.D., of RTI International in Research Triangle Park, N.C., and colleagues reviewed studies conducted in the United States from January 1998 through September 2009 and found that low income or less education, being uninsured, being Hispanic or Asian, being less acculturated into the United States, or having limited access to care were independently associated with screening underuse. The article also found evidence of screening overuse and misuse, and inadequate clinical discussions about screening.
"System- and policy-level interventions that target vulnerable populations are needed to reduce underuse," Holden and colleagues conclude. "Interventions aimed at reducing barriers by making the screening process easier are likely to be effective. Studies aimed at reducing overuse and misuse and at enhancing the quality and frequency of discussions about colorectal cancer screening options are needed."
Abstract - Steinwachs
Abstract - Holden