Colorectal cancer screening among African-American and white males in a VA general medicine practice

Dolan NC, Ferreira MR, Fitzgibbon ML, Davis TC, Rademaker AW, Liu D, Lee J, Wolf MS, Schmitt BP, Bennett CL. Colorectal cancer screening among African-American and white males in a VA general medicine practice. Poster session presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.

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.