Disparities in colorectal cancer (CRC) screening in an underserved population

Abstract

6569 Background: CRC is a common, potentially lethal, yet preventable disease. Screening tests for CRC are known to reduce the rate of death by detecting early cancer. To evaluate factors associated with the practice and impact of CRC screening, we reviewed a decade of CRC patients treated at an inner-city hospital. Methods: Under an IRB-approved protocol, data, including demographics, stage at diagnosis, utilization of screening tests, and insurance status, were obtained from CRC patients, at age 50 or above at diagnosis, treated between 1994 and 2004 at Santa Clara Valley Medical Center, a public hospital in the Silicon Valley. Chi-square test and multivariate regression analysis were used to evaluate factors associated with screening and its outcome. Results: We identified 331 cases of CRC patients who met the study criteria, with 50.5% (167) male and 49.5% (164) female patients. By ethnicity 36.6% (121) of the patients were Asian, 3.6% (12) Black, 22.8% (72) Hispanic, 37.8% (125) white, and 0.3% (1) other ethnicity. Only 5.7% (19) of the patients had been diagnosed by a screening colonoscopy, and 5.4% (18) of the patients had screening fecal occult blood test (FOBT). As a result, 9.4% (31) patients were diagnosed after either a positive colonoscopy or FOBT. Their stage distribution is presented in the table below. There was no association between the screening practice and gender, age, race or insurance status in this cohort. CRC diagnosed by screening test was significantly associated with survival benefit (p<0.01). Multivariate regression analysis revealed that survival was significantly associated with stage (p<0.05) and Hispanic race (p<0.01); but not screening test or insurance status. Conclusions: In this underserved population, even with a low rate of screening tests, screening for CRC is associated with earlier stage of CRC presentation which has been linked with survival benefit. Further studies are needed to identify barriers to CRC screening in this inner-city population. [Table: see text] No significant financial relationships to disclose.