Are patients with colonoscopy also more likely to undergo other cancer screening? A population-based analysis.

Abstract

401 Background: Colonoscopy use in the United States has been increasing but remains short of target rates, especially among minorities and lower SES; these same groups are also less likely to receive breast and prostate cancer screening. However, at a population level, it is not known whether disparities are accounted for by the same individuals. Methods: Using a 5% national random sample of fee-for-service Medicare beneficiaries, we identified patients ≥ 70 years in 2009. Medicare claims from 2004-2008 were used to identify receipt of prior colonoscopy and exclude previous cancer, and claims from 2009-10 were used to identify receipt of colonoscopy, mammography in women and PSA testing in men. Differences in mammography and PSA were compared between four groups: no prior colonoscopy (2004-8)/no colonoscopy in follow up (2009-10) (group 1), no prior colonoscopy/colonoscopy in follow up (group 2), prior colonoscopy/no colonoscopy in follow up (group 3), and prior colonoscopy/colonoscopy in follow-up (group 4). Differences were also evaluated in a multivariate logistic regression model that adjusted for SES and physician supply at the level of the hospital referral region (HRR). Results: 717,334 beneficiaries (453,945 women and 263,389 men) were included in the study. During 2009-2010, the frequency of mammography was 38.0%, PSA was 41.7% and colonoscopy was 16.1%. All three procedures were less frequently performed in patients who were older, nonwhite, and with higher comorbidity scores. The presence of additional cancer risk factors was also associated with screening. Screening receipt according to colonoscopy status is shown in the Table. Conclusions: In this population-based analysis, we found that individuals with repeat colonoscopy were also more likely to undergo other screening procedures, including mammography and PSA. The findings may be accounted for by patient factors as well as physician practice patterns. [Table: see text]