Healthcare system factors and colorectal cancer screening

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Family Medicine and Community Health; Meyers Primary Care Institute

Publication Date


Document Type



Aged; Barium Compounds; Colonoscopy; Colorectal Neoplasms; Cross-Sectional Studies; Female; Fluorides; Health Resources; Health Services Accessibility; Humans; Insurance Coverage; Male; Massachusetts; Middle Aged; Occult Blood; Sigmoidoscopy


Health Services Research | Primary Care


BACKGROUND: Developing effective programs to promote colorectal cancer (CRC) screening requires understanding of the effect of healthcare system factors on access to screening and adherence to guidelines.

METHODS: This study assessed the role of insurance status, type of plan, the frequency of preventive health visits, and provider recommendation on utilization of CRC screening tests using a cross-sectional, random-digit-dial survey of 1002 Massachusetts residents aged > or =50.

RESULTS: A broad definition of CRC screening status included colonoscopy or barium enema (screening or diagnostic) within 10 years, flexible sigmoidoscopy (FSIG) within 5 years, and fecal occult blood testing (FOBT) in the past year as options; 51.7% of subjects aged 50 to 64 and 61.5% of older subjects were current. The uninsured had the lowest current testing rate. Among insured participants, type of insurance had little impact on CRC testing; older subjects enrolled in HMOs had marginally higher rates, although not statistically significant. Increased frequency of preventive health visits and ever receiving a physician's recommendation for FSIG or ever receiving FOBT cards were associated with higher rates of CRC screening among both age groups.

CONCLUSIONS: Even when broad criteria are used to define current CRC screening status, a substantial proportion of the age-eligible population remains underscreened. Obtaining regular preventive care and receiving a physician's recommendation for screening appear to be potent facilitators of screening that should be considered in designing promotional efforts.


Am J Prev Med. 2002 Jul;23(1):28-35.

Journal/Book/Conference Title

American journal of preventive medicine

Related Resources

Link to Article in PubMed

PubMed ID