Barriers to colorectal cancer screening among Medicare consumers

Am J Prev Med. 2006 Apr;30(4):313-9. doi: 10.1016/j.amepre.2005.11.006.


Background: Few studies have examined lack of physician recommendation and other reasons for under-utilization of colorectal cancer (CRC) screening in the Medicare population.

Methods: Data from a telephone survey conducted in 2001 in a random sample of Medicare consumers residing in North and South Carolina were used to examine barriers to CRC screening, focusing on consumers' reports of receiving a physician's recommendation to obtain CRC screening and reasons for not being screened. Analyses were restricted to respondents with no history of CRC (n = 1901). Descriptive statistics were used to characterize respondents' CRC screening status, receipt of a physician's recommendation for screening, and reasons for not being screened. Logistic regression modeling was used to examine factors associated with receiving a physician recommendation for fecal occult blood test, sigmoidoscopy, colonoscopy, any endoscopy, and any CRC test.

Results: Thirty-one percent of Medicare consumers had never been tested for CRC, and 18% had been tested but were not current with Medicare-covered intervals. Overall, 28% reported not receiving a physician recommendation for screening. Predictors of receiving a physician recommendation included sociodemographic (younger age, white race, more education), health status (increased CRC risk, comorbidity), and healthcare access (had a routine/preventive care visit in the past 12 months) factors. Lack of knowledge/awareness and the physician not ordering the test were commonly cited reasons for not having CRC tests.

Conclusions: Colorectal cancer screening was under-utilized by Medicare consumers in two states, and lack of physician recommendation was an important contributing factor. Providing a benefit under the Medicare program does not ensure its widespread use by consumers or their physicians.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Colonoscopy / statistics & numerical data*
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / prevention & control*
  • Communication Barriers*
  • Female
  • Guidelines as Topic / standards
  • Humans
  • Male
  • Mass Screening*
  • Medicare*
  • Middle Aged
  • North Carolina / epidemiology
  • Occult Blood
  • Physician-Patient Relations
  • Primary Health Care*
  • Referral and Consultation* / statistics & numerical data
  • Sigmoidoscopes / statistics & numerical data
  • South Carolina / epidemiology