Colorectal cancer is the third most common cancer in the U.S. and the third leading cause of cancer-related deaths—behind lung and bronchial cancer and prostate cancer (men) or breast cancer (women). Routine screenings for colorectal cancer, therefore, are imperative tools for early detection. Currently a handful of colorectal cancer screens are available—two of which include sigmoidoscopy and colonoscopy. While the recommended frequency of screenings is often contingent upon the type of screen performed, the sigmoidoscopy is generally recommended every five years while the colonoscopy is generally recommended every decade; regardless of the type of screen, colorectal cancer screenings should be considered at 50 years of age for adults deemed to be at average risk.

In recognition of March as Colorectal Cancer Awareness month, the following article presents information from PHMC’s 2006 Household Health Survey on colorectal cancer screening behaviors among adults 50 years or older residing in the five-county Southeastern Pennsylvania (SEPA) region. More specifically, this article pays particular attention to adults 50 years or older who have never received either a sigmoidoscopy or colonoscopy in their lifetime. Although adults may have received another type of colorectal cancer screening—and therefore, not captured in these data—sigmoidoscopy and colonoscopy screenings are relatively common.

Screening Frequency, SEPA
More than three-fifths of adults 50 years or older (61.1%) have either had a sigmoidoscopy or colonoscopy screen for colorectal cancer within the previous ten years; 2.0% of adults either had a sigmoidoscopy or colonoscopy more than ten years ago; and approximately two-fifths of adults (36.9%) have never had either a sigmoidoscopy or colonoscopy, which represents approximately 484,000 adults in the SEPA region who have never received either screen (Figure 1). The percentage of adults 50 years or older who have never had either screening performed has declined over time: 43.4% for adults in 2004 and 42.7% for adults in 2002.

Demographic Characteristics, SEPA
Examining the demographic characteristics of adults 50 years or older residing in the SEPA area reveal specific sub-groups of the population have never received either a sigmoidoscopy or colonoscopy screen for colorectal cancer in their lifetime.

·  Two-fifths of women (40.0%), compared to one-third of men (33.5%), have never received either a sigmoidoscopy or colonoscopy.

·  While nearly one-half of adults 50-59 years (45.0%) have never had either colorectal cancer screen, approximately three-tenths of adults 60-74 years (31.7%) and adults 75+ years (27.5%) have also never had either screening for colorectal cancer.

·  Nearly one-half of Latino adults (47.5%), compared to 37.1% of Black adults and 36.1% of White adults, have never received either a sigmoidoscopy or colonoscopy.

·  More than two-fifths of adults living in poverty (43.8%), compared to more than one-third of adults not living in poverty (36.2%), have never received either screening.

Access to Care, SEPA
Having access to a care—through health insurance coverage, a regular source of care, as well as routine visits to a health care provider—can increase the likelihood that preventive screenings are performed in a timely manner. However, among adults 50 years or older living in SEPA, those without access to care are more likely than those with access to care to have never had either a sigmoidoscopy or colonoscopy screen for colorectal cancer in their lifetime.

·  More than two-thirds of adults without any health insurance coverage (67.4%), compared to more than one-third of adults with health insurance coverage (35.9%), have never received either a sigmoidoscopy or colonoscopy screen.

·  Nearly three-fifths of adults without a regular source of care (54.6%), compared to more than one-third of adults with a regular source of care (35.7%), have never had either screen for colorectal cancer.

·  While more than one-third of adults who have not visited with a health care professional in the past year (34.2%) have never had either colorectal cancer screen, nearly three-fifths of adults who have not visited a health care professional between one and two years (56.1%) and more than three-quarters of adults who have not visited a health care professional in more than two years (75.4%) have never had either colorectal cancer screen.

Conclusion
Findings presented in this article provide a picture of adults 50 years or older who have never received either a sigmoidoscopy or colonoscopy screen for colorectal cancer. For example, women (40.0%) are more likely than men (33.5%) to have never had either screen for colorectal cancer. Nearly one-half of Latino adults (47.1%) have never had either screen, compared to Black (37.1%) and White (36.1%) adults. In addition, poor adults (43.8%) are more likely than non-poor adults (36.2%) to have never had either colorectal cancer screen. Furthermore, adults without any health insurance coverage (67.4%) are nearly twice as likely as adults with health insurance coverage (35.9%) to have never received either a sigmoidoscopy or colonoscopy screen. As the Healthy People 2010 deadline approaches, of which reducing colorectal cancer mortality remains an important target, detecting pre-cancerous polyps, through routine screenings, remains an important step in reducing mortality associated with colorectal cancer. For more information about the findings presented in this article, please contact Nicole Dreisbach, CHDB Research Associate, at 215-731-2168 or nicoled@phmc.org.

References:
National Cancer Institute. A Snapshot of Colorectal Cancer. Bethesda: National Cancer Institute, 2006. Available at: http://planning.cancer.gov/disease/Colorectal-Snapshot.pdf

American Cancer Society, Cancer Facts and Figures 2007. Atlanta: American Cancer Society, 2007. Available at: http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf

Notes:
Due to a small sample size, Asian adults were excluded from the analysis.
Poverty level is defined as below or at/above 100% of the Federal Poverty Level, and is calculated based on family size and household income.