The 130th Annual Meeting of APHA

Abstract #45390

Sherri Sheinfeld Gorin, PhD¹, Alfred Neugut, MD, PhD², Grace Hillyer, MPH¹, Ashfaque Hossain, MMB, MPH¹, Mary Riley Jacome, MS¹, Alfred Ashford, MD³, Rafael Lantigua, MD⁴, Donald Gemson, MD¹, and Andrea Troxel, PhD¹. (1) Mailman School of Public Health of Columbia University, Columbia University, Department of Sociomedical Sciences and Epidemiology, 600 West 168th Street, New York, NY 11733, 212-305-1185, ssg19@columbia.edu, (2) College of Physicians and Surgeons, Columbia University, 600 West 168th Street, New York, NY 11733, (3) Department of Medicine, Harlem Hospital Center, MLK Pavilion, New York, NY 11733, (4) Department of Medicine, Columbia University, 622 West 168th Street, New York, NY 11733

Physician recommendation is key to colorectal cancer screening. The aim of this study is to assess the effect of community socioeconomic, racial/ethnic, and primary care physician characteristics on colorectal cancer screening practices (via self report). In-person interviews were conducted among 264 urban primary care physicians working in two large urban communities, one highly affluent and primarily white ([Upper]), and the second, impoverished, and generally populated by African Americans and Hispanics ([Lower]). Physicians practicing in the Upper areas had more years of practice (p<.00001), than were primary care physicians in the Lower communities. Primary care physicians in the Upper communities were five times less likely to accept Medicaid patients (p<.00001), and saw four times more white patients (p<.00001) than those in Lower communities. Although self report may have overstated the rates of screening, primary care physicians in Upper areas were less likely to recommend the home fecal occult blood test for routine screening of those >age 50 than were their counterparts (80% vs. 69%; p<.05), and less likely to recommend flexible sigmoidoscopy (37% vs. 54%; p<.01). Conversely, Upper physicians were significantly more likely to administer a colonoscopy than were practitioners in Lower areas (88% vs. 55%; p<.00001). These findings suggest that vast disparities exist in the choice of screening modalities, and in the rates of screening between communities that are homogeneously white with high affluence and those of color and poverty, thus influencing the colorectal cancer-related morbidity and mortality of their residents.

Learning Objectives: At the end of the session, the learner will be able to

• identify evidence-based colorectal cancer (CRC) screening approaches, that is, those techniques that reduce morbidity and mortality;
• evaluate the role of primary care physicians in CRC screening among underserved communities;
• analyze the role of community and patient socioeconomic status, race and ethnicity in access to CRC screening;
• list 2 ramifications of disparate access to CRC screening among underserved communities.

Keywords: Cancer Screening, Cancer Prevention

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.