Although new diagnoses of colon and rectal cancer are decreasing in the United States, the benefit does not reach everyone.
No matter where they lived, incidence of colorectal cancer dropped significantly between 1995 and 2004 for white Americans aged 65 and over, most of whom have Medicare that covers colonoscopy screening. However, colorectal cancer rates for whites from 50 to 64 did not fall if they lived in rural areas or counties where there was poverty, lack of insurance, or few primary care providers.
African Americans only benefited from reduced incidence if they were over 64 and living in an affluent community.
Researchers from the American Cancer Society in Atlanta reviewed colorectal cancer incidence rates in metropolitan and rural counties across the United States looking at poverty, age, race, and ethnicity. They also measured access to health care by the supply of primary care physicians and amount of insurance coverage.
Medicare made a difference for older people. Colorectal cancer fell for whites over 64 in all areas, including those with poverty or few primary care physicians. However, for Hispanics and African Americans eligible for Medicare, only those living in more affluent counties without poverty and with a good supply of primary care saw colorectal cancer rates decrease.
For younger whites from 50 to 64, not covered by Medicare, rates did not decrease if they lived in a county with high poverty, many uninsured, lack of primary care physicians, or in a rural area.
Hispanics and African Americans under 65 saw no reduction in incidence rates in general, no matter where they lived. If they were 65, rates did not decrease in counties with poverty, lack of insurance, and few primary care physicians. African Americans also did worse in rural communities.
Colonoscopy screening increased significantly for whites in both age groups. However, screening with colonoscopy didn’t improve for Hispanics below Medicare age at all, nor for Hispanics over 64 who lived in areas with high poverty.
Likewise African Americans from 50 to 64 saw no increase in colonoscopies if they lived where there were high rates of uninsured. Colonoscopy screening for African Americans old enough for Medicare didn’t improve where there was poverty or a poor supply of primary care physicians.
Writing in Cancer Causes and Control, Yong Ping Hao and colleagues concluded,
Individuals residing in poorer communities with lower access to medical care have not experienced the reduction in colorectal cancer incidence rates that have benefited more affluent communities, and that this is likely explained in part by lower utilization of colorectal endoscopic screening even in older populations with coverage through Medicare. Further research is needed on factors that explain the disparities and potential interventions to address them.