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Screening Rates Improving, but Inequalities Remain

2008 Screening Rates

One out of three Americans who needs colorectal cancer screening hasn’t gotten it.

There are 22 million men and women in the US who haven’t had a life-saving test than can prevent colorectal cancer.

But the good news is that screening rates are going up.  In 2000, half of people who should have been screened reported a current test.  Now almost two-thirds have colorectal cancer screening up-to-date

The bad news is that screening rates for the uninsured are almost half those for people with insurance. 

According to the Centers for Disease Control, 62.9 percent of US adults from 50 to 75 were current with colorectal cancer screening.  They either had a fecal occult blood test (FOBT) in the past year or a sigmoidoscopy or colonoscopy during the past 10 years.  That’s up from 51.9 percent in 2000.

The figures come from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey.  The BRFSS surveyors randomly dial nearly half a million Americans to ask about their health.  In 2008 BRFSS reached over 201,000 adults from age 50 to 75 to ask if they had ever used “a special kit at home to determine whether the stool contains blood (FOBT)” or had a “tube inserted into the rectum to view the colon for signs of cancer or other health problems (sigmoidoscopy or colonoscopy)” and when these tests were last done.

Overall US Screening in 2008

  • 14.1 percent said they had an FOBT within the past year.
  • 58.5 percent had sigmoidoscopy or colonoscopy sometime in the past 10 years.
  • 62.9 percent had either FOBT or an endoscopy and were up-to-date.

However, screening rates weren’t consistent.  Some groups fell substantially below the national 62.9 percent, particularly those with no health insurance, less than a high school education, or limited income.

There was little difference in rates for men or women or for black or whites.

Health Insurance

  • Insured — 65.7 percent
  • Not insured — 35.6 percent

Age

  • 50 to 59 — 53.9 percent
  • 60 to 69 — 71.1 percent
  • 70 to 75 — 75.8 percent

Race and Ethnicity

  • White — 65.9 percent
  • Black– 62.0 percent
  • Asian/Pacific Islander — 55.5 percent
  • American Indian/Alaskan Native — 54.4 percent
  • Non-Hispanic — 64.2 percent
  • Hispanic — 49.8 percent

Income

  • Less than $15,000 — 47.6 percent
  • $15,000 to $34,999 — 54.0 percent
  • $35,000 to $49,999 — 61.3 percent
  • $50,000 to $74,999 — 72.9 percent

Education

  • less than high school — 46.1 percent
  • high school graduate — 58.1 percent
  • some college/technical school — 63.7 percent
  • college graduate –70.6 percent

There are also differences in screening rates among the states with 74 percent of people up-to-date  in 3 northeastern states in Maine, Delaware, and Massachusetts. The lowest rates occurred in the central and western regions in Oklahoma (53 percent), Arkansas (53 percent), and Idaho (54 percent).

Line Graph of changes in screening rates

The CDC estimates that if current trends in health behaviors, screening, and treatment continue, there should be a 36 percent decrease in the rate of colorectal cancer deaths by 2020.

Led by L.C. Richardson, MD, the CDC team concluded,

CRC screening rates continue to increase in the United States. Underscreening persists for certain racial/ethnic groups, lower socioeconomic groups, and the uninsured.

SOURCERichardson et al., Vital Signs: Colorectal Cancer Screening Among Adults Aged 50–75 Years — United States, 2008, CDC Morbidity and Mortality Weekly Report, online July 6, 2010.

Vital Signs: Colorectal Cancer Screening Among Adults Aged 50–75 Years — United States, 2008

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