Colorectal cancer test use--Maryland, 2002-2006

Abstract

During 2000-2004, Maryland had the thirteenth highest mortality rate for colorectal cancer (CRC) among the 50 states and the District of Columbia. The American Cancer Society (ACS), the U.S. Preventive Services Task Force, and other organizations recommend that adults begin CRC screening at age 50 years if they are at average risk for CRC and before age 50 years if they are at increased risk. For those at average risk, ACS recommends screening with 1) a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year, 2) flexible sigmoidoscopy every 5 years, 3) an annual FOBT or FIT combined with flexible sigmoidoscopy every 5 years, 4) double-contrast barium enema (DCBE) every 5 years, or 5) colonoscopy every 10 years. In 2002, the Maryland Department of Health and Mental Hygiene initiated the Maryland Cancer Survey (MCS) to assess testing prevalence and risk behaviors for seven types of cancer, including CRC. Reducing CRC mortality and disparities in CRC incidence and mortality are goals described in Maryland's Comprehensive Cancer Control Plan (MCCCP). As milestones toward these goals, Maryland set the following targets for 2008 for persons aged > or =50 years: 1) decrease the percentage of Maryland residents who have never been screened for CRC to < or =15% (from a 2002 baseline of 25.9%); 2) increase the percentage of residents who are up to date with CRC screening (per ACS guidelines) to > or =73% (from a 2002 baseline of 63.8%); and 3) increase the percentage of residents who have been screened with either colonoscopy in the past 10 years, or FOBT in the past year plus flexible sigmoidoscopy in the past 5 years, to > or =57% (from a baseline of 46.5% in 2002). This report describes trends in CRC test use based on results from MCS surveys completed in 2002, 2004, and 2006. The results indicated a significant decline (6.1 percentage points) in the percentage of Maryland residents aged > or =50 years who had never been tested for CRC, a 5.4 percentage-point increase in prevalence of up-to-date testing by any method, and a 13.9 percentage-point increase in prevalence of either colonoscopy in the past 10 years or FOBT in the past year plus flexible sigmoidoscopy in the past 5 years. However, Maryland residents who were neither white nor black (i.e., persons of other races) had a significantly lower prevalence of ever having a CRC test, as did persons without health insurance or those without a recent checkup. Although overall increases in CRC testing reflect substantial progress in Maryland, additional measures are needed to increase CRC testing among racial minority groups and the medically underserved.