Trends in self-reported health care provider recommendations for colorectal cancer screening by race

Abstract

Objective: To examine whether a racial difference exists in self-reported recommendations for colorectal cancer screening from a health care provider, and whether this difference has changed over time.

Method: Secondary analysis of the 2002, 2004, 2006, and 2008 Maryland Cancer Surveys, cross-sectional population-based random-digit-dial surveys on cancer screening. Participants were 11,368 White and 2495 Black Maryland residents age ≥ 50 years.

Results: For each race, recommendations for colonoscopy/sigmoidoscopy increased over time (67%-83% for Whites, 57%-74% for Blacks; p<0.001 for both), but the race difference remained approximately 10% at each survey. Among respondents without a colonoscopy in the last 10 years (n=5081), recommendations for fecal occult blood test (FOBT) in the past year decreased over time for Whites (37%-24%, p<0.001) and for Blacks (36-28%, p=0.05), with no difference by race in any year. In multivariable analysis, the effect of race on the odds of reporting a provider recommendation did not vary significantly across time for either test (p=0.80 for colonoscopy/sigmoidoscopy, p=0.24 for FOBT for effect modification by year).

Conclusion: Whites were more likely than Blacks to report ever receiving a provider recommendation for colonoscopy/sigmoidoscopy. Although the proportion of patients receiving recommendations for colonoscopy/sigmoidoscopy increased over time, the gap between races remained unchanged.

Figure 1

Percentage reporting ever receiving a health care provider recommendation for colonoscopy or sigmoidoscopy, by survey year and race, Maryland Cancer Survey 2002, 2004, 2006, and 2008. p-values derived from Chi-square test on comparison between races for each survey year. p-value for interaction between race and survey year in unadjusted model of reporting recommendations for colonoscopy/sigmoidoscopy was 0.55.

Figure 2

Percentage reporting receiving a health care provider recommendation for fecal occult blood test in the past year, by survey year and race, among respondents not up-to-date on colonoscopy, Maryland Cancer Survey 2002, 2004, 2006, and 2008. p-values derived from Chi-square test on comparison between races for each survey year. p-value for interaction between race and survey year in unadjusted model of reporting recommendations for fecal occult blood test in past year was 0.31.