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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3045 — Colorectal Cancer Screening Among African-American and White Males in a VA General Medicine Practice

Author List:
Dolan NC (Department of Medicine and The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL)
Ferreira MR (VA Midwest Center for Health Services and Policy Research; Jesse Brown VA Medical Center; Department of Medicine, Northwestern University, Chicago, IL)
Fitzgibbon ML (Department of Psychiatry and Behavioral Sciences; and The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL)
Davis TC (Department of Family Medicine, Louisiana State University Medical School, Shreveport, Louisiana)
Rademaker AW (The Robert H. Lurie Comprehensive Cancer Center and the Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine)
Liu D (Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine)
Lee J (Jesse Brown VA Medical Center)
Wolf MS (VA Midwest Center for Health Services and Policy Research; Department of Medicine and Center for Healthcare Studies, Northwestern University)
Schmitt BP (Jesse Brown VA Medical Center; Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL)
Bennett CL (VA Midwest Center for Health Services and Policy Research; Jesse Brown VA Medical Center; Department of Medicine, Northwestern University, Chicago, IL)

Objectives:
Population-based studies from Medicare and privately insured individuals have consistently identified lower rates of colorectal cancer screening tests among African-American versus white individuals. The purpose of this study was to evaluate whether, at a Veteran Affairs (VA) medical center, similar racial/ethnic differences in colorectal cancer screening could be identified.

Methods:
Study participants were male veterans, age 50 and older, attending a general medicine clinic in a VA hospital, who had not had either a fecal occult blood test (FOBT) within the past year or a flexible sigmoidoscopy / colonoscopy within the past five years. Based on review of electronic medical records, rates of physician recommendation for FOBT, flexible sigmoidoscopy, or colonoscopy, and patient completion of these tests were obtained and compared by race/ethnicity.

Results:
Forty percent of 1599 veterans were up to date on CRC screening at the time of their index visit; rates were similar between African-American and white veterans (40.7% vs. 39.3%, p = 0.56). Among the 905 unscreened patients, similar proportions of African-American and white patients received a physician’s recommendation for colorectal cancer screening (71.0% vs. 68.2%, p = 0.44). By the end of the study, among these previously unscreened veterans, 36.3% of the African-American patients and 28.9% of white patients had undergone FOBT and/or flexible sigmoidoscopy / colonoscopy (p = 0.03).

Implications:
In contrast to other settings, in a general medicine clinic at a VA hospital, rates of colorectal cancer screening tests were not lower for African-American patients compared to white patients.

Impacts:
There is wide spread concern over the disproportionate burden of CRC among African-Americans in non-VA settings. There may be less of a “racial divide” in the VA health care system, given there is equal access, regardless of race/ethnicity, which sharply contrasts with other insurance based and self-pay health care settings.


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