Promising way to prevent disparities in screening for colorectal cancer -
Health Group, Kaiser Permanente researchers in JAMA Internal Medicine
People living in poverty are less likely to be screened regularly for colorectal cancer and more likely to develop the disease and die. How to end these disparities and increase screening rates, lower rates of disease and prevent death? A promising way is to post fecal immunochemical tests (a new stool test type) for populations, Beverly B. Green, MD, MPH, and Gloria D. Coronado, PhD, wrote in the June 17 JAMA Internal Medicine .
Dr. Green is a doctor of Health Group and associate investigator at Group Health Research Institute. Dr. Coronado is a senior researcher and scientist Mitch Greenlick gifted to health disparities in the center of Kaiser Permanente for Health Research in Portland. The newspaper invited them to comment on a study that David W. Baker, MD, MPH, of Northwestern University conducted and published in the same issue of the journal.
Drs. Green and Coronado Baker applauded the study to achieve the repeat screening rates of over 82 percent in a largely low-income community. But they were disappointed that only 60 percent of people with diagnostic colonoscopy follow-up test positive screening stool over. "The lack of follow-up colonoscopy to defeat the purpose of a stool test screening program," said Dr. Green, who is also clinical assistant professor at the University of Washington School of Medicine.
previous studies have shown that when people with low incomes get screening for colorectal cancer, they tend to prefer the option of a stool test in the privacy of their own home. But when test is "positive" (detect microscopic blood in the stool), people need to get a second test. a diagnostic colonoscopy followed after a positive stool test, nearly one third of advanced pre-cancers which can be removed during colonoscopy followed and 4 percent for colorectal cancer.
"for many people, obstacles to receiving the diagnostic colonoscopy necessary follow include the cost," said Dr. Green . For example, the Affordable Care Act (ACA) requires full coverage of screening tests that the Preventive Services Task Force of the United States (USPSTF) recommends no charge-out-of-pocket. But it covers only the first test that a person chooses, a stool test, colonoscopy, sigmoidoscopy not test any monitoring or diagnosis. That's why Drs. Green and Coronado previously insisted that the ACA be amended to cover co-pays for follow-up colonoscopy after a positive stool test or flexible sigmoidoscopy. Otherwise, people who choose them as their first tests could be to face high, unexpected costs of monitoring tests and the disparities in screening could worsen.
"Furthermore, the Medicaid insurance most states pay for both saddles and the follow-up colonoscopy tests at no cost out-of-pocket patients," said Dr. Coronado . "So disparities in colorectal cancer deaths could quickly diminish in states that have opted Medicaid expansion."
Dr. Green previously shown in a randomized trial that screening for colorectal cancer doubled when the electronic health record Health Group was used in a new way to identify people who need screening and give them stepped increases in support. And Drs. Green and Coronado showed it was possible to use a population-based program to send stool tests for those in safety net clinics.
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