Abstract B96: Trends in colorectal cancer screening with home-based fecal occult blood test (FOBT) in adults aged 50–64 years, 2000–2008

Abstract

Abstract Introduction: Screening for colorectal cancer (CRC) in asymptomatic average risk populations reduces CRC incidence and mortality. Annual home-based fecal occult blood testing (FOBT) has been recommended as a CRC screening modality in average-risk adults aged 50 and older. National surveys have reported declines in FOBT screening rates in the last decade, but it is unknown whether these declines have extended across all socioeconomic status (SES) and racial/ethnic groups, and the changes relative to endoscopic screening have not been evaluated. Methods: Data on respondents aged 50–64 years were from the Cancer Control Module administered to sampled adults National Health Interview Surveys in 2000, 2005, and 2008. Weighted analyses and multivariate logistic regression were used to study trends in the use of home FOBT testing in the past year and endoscopic test in the past 10 years. Results: Overall, the prevalence of home FOBT in the past year declined 5.9% points (95% CI: 4.5%, 7.3%) between 2000 and 2008. SES differences in trends were observed wherein significant declines were restricted to higher-SES groups (those with private and military insurance, those with a usual source of care, those with a high school degree or higher, those classified as not poor, those born in the US), whereas lower-SES (uninsured and the publicly-insured, those without a usual source of care, those with less than a high school education, the poor and the near poor, and immigrants to the US) did not experience significant changes in FOBT prevalence during this time period. FOBT rates in Hispanics did not change significantly during this time, whereas non-Hispanic whites and non-Hispanic blacks experienced significant declines. Coincident with declines in FOBT prevalence during this time, endoscopic screening prevalence increased consistently in higher-SES groups. Fewer lower-SES groups experienced increases in endoscopic screening prevalence, with most increases being of a lower magnitude than in the higher-SES subgroups. Conclusions: Socially and economically disadvantaged groups experienced little or no change in FOBT rates from 2000 to 2008. There has been a significant shift from FOBT to endoscopic screening in higher-SES and a few lower-SES groups, but the extent of this shift in lower-SES groups appeared to be smaller than in higher-SES groups. Programs promoting annual screening with high-sensitivity guaiac-based or immunochemical FOBT represent an appropriate and low cost alternative to colonosopy screening, provided that these programs consider patient- and physician attitudes, knowledge and preferences, and systems-issues related to referral, adherence, test quality assurance, and adequate follow-up of positive test results. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B96.