Skip to main content
PMC home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2007 Dec;99(12):1371–1380.

Intraurban influences on physician colorectal cancer screening practices.

Sherri Sheinfeld Gorin 1, Alfred R Ashford 1, Rafael Lantigua 1, Farida Hajiani 1, Rebeca Franco 1, Julia E Heck 1, Donald Gemson 1
PMCID: PMC2575938  PMID: 18229773

Abstract

BACKGROUND: Community social and economic resources influence colorectal (CRC) screening decisions by physicians and patients. The aim of this study is to systematically assess the differences in screening recommendations of primary care physicians within two urban communities that are distinct in socioeconomic characteristics. METHODS: Two-hundred-sixty-four primary care community (i.e., not hospital-based) physicians were stratified by community. Using self-report questionnaires, we examined primary care physicians' CRC screening practices, knowledge of risk factors and perceived physician and patient barriers to screening, Physicians practicing in upper-socioeconomic status (SES) communities were compared with those of participants practicing in lower SES communities. RESULTS: Physicians practicing in low-SES urban communities were significantly more likely to screen with fecal occult blood test than were physicians in upper-SES areas. Alternatively, upper-SES physicians were significantly more likely to recommend screening colonoscopy than were lower-SES physicians. The number of physicians (N=11) who screened for CRC using the double-contrast barium enema were few. CONCLUSIONS: Community-level SES influences physician cancer screening practices. Further understanding of these relationships may guide the development of interventions targeted to specific neighborhoods within urban areas.

Full text

PDF
1371

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlquist D. A. Fecal occult blood testing for colorectal cancer. Can we afford to do this? Gastroenterol Clin North Am. 1997 Mar;26(1):41–55. doi: 10.1016/s0889-8553(05)70282-x. [DOI] [PubMed] [Google Scholar]
  2. Andersen Ronald M., Yu Hongjian, Wyn Roberta, Davidson Pamela L., Brown E. Richard, Teleki Stephanie. Access to medical care for low-income persons: how do communities make a difference? Med Care Res Rev. 2002 Dec;59(4):384–411. doi: 10.1177/107755802237808. [DOI] [PubMed] [Google Scholar]
  3. Baldwin Laura-Mae, Adamache Walter, Klabunde Carrie N., Kenward Kevin, Dahlman Celia, L Warren Joan. Linking physician characteristics and medicare claims data: issues in data availability, quality, and measurement. Med Care. 2002 Aug;40(8 Suppl):IV–82-95. doi: 10.1097/00005650-200208001-00012. [DOI] [PubMed] [Google Scholar]
  4. Brown Martin L., Klabunde Carrie N., Mysliwiec Pauline. Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices. Am J Med. 2003 Aug 1;115(2):129–133. doi: 10.1016/s0002-9343(03)00297-3. [DOI] [PubMed] [Google Scholar]
  5. Centers for Medicare & Medicaid Services (CMS), HHS Medicare program; revisions to payment policies and five-year review of and adjustments to the relative value units under the physician fee schedule for calendar year 2002. Final rule with comment period. Fed Regist. 2001 Nov 1;66(212):55245–55503. [PubMed] [Google Scholar]
  6. Cooper G. S., Yuan Z., Rimm A. A. Racial disparity in the incidence and case-fatality of colorectal cancer: analysis of 329 United States counties. Cancer Epidemiol Biomarkers Prev. 1997 Apr;6(4):283–285. [PubMed] [Google Scholar]
  7. Cooper G. S., Yuan Z., Veri L., Rimm A. A., Stange K. C. Colorectal carcinoma screening attitudes and practices among primary care physicians in counties at extremes of either high or low cancer case-fatality. Cancer. 1999 Nov 1;86(9):1669–1674. doi: 10.1002/(sici)1097-0142(19991101)86:9<1669::aid-cncr7>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  8. Cram Peter, Fendrick A. Mark, Inadomi John, Cowen Mark E., Carpenter Daniel, Vijan Sandeep. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med. 2003 Jul 14;163(13):1601–1605. doi: 10.1001/archinte.163.13.1601. [DOI] [PubMed] [Google Scholar]
  9. Demissie Kitaw, Oluwole Olalekan O., Balasubramanian Bijal A., Osinubi Omowunmi O., August David, Rhoads George G. Racial differences in the treatment of colorectal cancer: a comparison of surgical and radiation therapy between Whites and Blacks. Ann Epidemiol. 2004 Mar;14(3):215–221. doi: 10.1016/j.annepidem.2003.08.002. [DOI] [PubMed] [Google Scholar]
  10. Diez Roux A. V. Investigating neighborhood and area effects on health. Am J Public Health. 2001 Nov;91(11):1783–1789. doi: 10.2105/ajph.91.11.1783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Diez-Roux A. V., Nieto F. J., Muntaner C., Tyroler H. A., Comstock G. W., Shahar E., Cooper L. S., Watson R. L., Szklo M. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997 Jul 1;146(1):48–63. doi: 10.1093/oxfordjournals.aje.a009191. [DOI] [PubMed] [Google Scholar]
  12. Dominitz J. A., Provenzale D. Patient preferences and quality of life associated with colorectal cancer screening. Am J Gastroenterol. 1997 Dec;92(12):2171–2178. [PubMed] [Google Scholar]
  13. Freeman Harold P., Alshafie Tarek A. Colorectal carcinoma in poor blacks. Cancer. 2002 May 1;94(9):2327–2332. doi: 10.1002/cncr.10486. [DOI] [PubMed] [Google Scholar]
  14. Freeman Harold P. Poverty, culture, and social injustice: determinants of cancer disparities. CA Cancer J Clin. 2004 Mar-Apr;54(2):72–77. doi: 10.3322/canjclin.54.2.72. [DOI] [PubMed] [Google Scholar]
  15. Gorin S. S., Jacobson J. Diet and breast cancer surveillance behaviors among Harlem women. Ann N Y Acad Sci. 2001 Dec;952:153–160. doi: 10.1111/j.1749-6632.2001.tb02736.x. [DOI] [PubMed] [Google Scholar]
  16. Honda Keiko, Gorin Sherri Sheinfeld. A model of stage of change to recommend colonoscopy among urban primary care physicians. Health Psychol. 2006 Jan;25(1):65–73. doi: 10.1037/0278-6133.25.1.65. [DOI] [PubMed] [Google Scholar]
  17. Jørgensen O. D., Kronborg O., Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut. 2002 Jan;50(1):29–32. doi: 10.1136/gut.50.1.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Katz J. N. Patient preferences and health disparities. JAMA. 2001 Sep 26;286(12):1506–1509. doi: 10.1001/jama.286.12.1506. [DOI] [PubMed] [Google Scholar]
  19. Klabunde Carrie N., Frame Paul S., Meadow Ann, Jones Elizabeth, Nadel Marion, Vernon Sally W. A national survey of primary care physicians' colorectal cancer screening recommendations and practices. Prev Med. 2003 Mar;36(3):352–362. doi: 10.1016/s0091-7435(02)00066-x. [DOI] [PubMed] [Google Scholar]
  20. Krieger Nancy, Chen Jarvis T., Waterman Pamela D., Soobader Mah-Jabeen, Subramanian S. V., Carson Rosa. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project. Am J Epidemiol. 2002 Sep 1;156(5):471–482. doi: 10.1093/aje/kwf068. [DOI] [PubMed] [Google Scholar]
  21. LaVeist T. A., Wallace J. M., Jr Health risk and inequitable distribution of liquor stores in African American neighborhood. Soc Sci Med. 2000 Aug;51(4):613–617. doi: 10.1016/s0277-9536(00)00004-6. [DOI] [PubMed] [Google Scholar]
  22. Leard L. E., Savides T. J., Ganiats T. G. Patient preferences for colorectal cancer screening. J Fam Pract. 1997 Sep;45(3):211–218. [PubMed] [Google Scholar]
  23. Lemmel G. T., Haseman J. H., Rex D. K., Rahmani E. Neoplasia distal to the splenic flexure in patients with proximal colon cancer. Gastrointest Endosc. 1996 Aug;44(2):109–111. doi: 10.1016/s0016-5107(96)70125-6. [DOI] [PubMed] [Google Scholar]
  24. Levin T. R., Farraye F. A., Schoen R. E., Hoff G., Atkin W., Bond J. H., Winawer S., Burt R. W., Johnson D. A., Kirk L. M. Quality in the technical performance of screening flexible sigmoidoscopy: recommendations of an international multi-society task group. Gut. 2005 Jun;54(6):807–813. doi: 10.1136/gut.2004.052282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lieberman D. A., Weiss D. G., Bond J. H., Ahnen D. J., Garewal H., Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000 Jul 20;343(3):162–168. doi: 10.1056/NEJM200007203430301. [DOI] [PubMed] [Google Scholar]
  26. Lieberman D. A., Weiss D. G., Veterans Affairs Cooperative Study Group 380 One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med. 2001 Aug 23;345(8):555–560. doi: 10.1056/NEJMoa010328. [DOI] [PubMed] [Google Scholar]
  27. Mandel J. S., Bond J. H., Church T. R., Snover D. C., Bradley G. M., Schuman L. M., Ederer F. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993 May 13;328(19):1365–1371. doi: 10.1056/NEJM199305133281901. [DOI] [PubMed] [Google Scholar]
  28. McMahon L. F., Jr, Wolfe R. A., Huang S., Tedeschi P., Manning W., Jr, Edlund M. J. Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population. Med Care. 1999 Jul;37(7):712–717. doi: 10.1097/00005650-199907000-00011. [DOI] [PubMed] [Google Scholar]
  29. Meissner Helen I., Breen Nancy, Klabunde Carrie N., Vernon Sally W. Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev. 2006 Feb;15(2):389–394. doi: 10.1158/1055-9965.EPI-05-0678. [DOI] [PubMed] [Google Scholar]
  30. Montaño D. E., Phillips W. R. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health. 1995 Jun;85(6):795–800. doi: 10.2105/ajph.85.6.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Morland Kimberly, Wing Steve, Diez Roux Ana, Poole Charles. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002 Jan;22(1):23–29. doi: 10.1016/s0749-3797(01)00403-2. [DOI] [PubMed] [Google Scholar]
  32. Neugut A. I., Timony D., Murray T. Colorectal cancer: differences between community and geographically distant patients seen at an urban medical center. Dis Colon Rectum. 1991 Jan;34(1):64–68. doi: 10.1007/BF02050210. [DOI] [PubMed] [Google Scholar]
  33. Newcomb P. A., Norfleet R. G., Storer B. E., Surawicz T. S., Marcus P. M. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992 Oct 21;84(20):1572–1575. doi: 10.1093/jnci/84.20.1572. [DOI] [PubMed] [Google Scholar]
  34. Newcomb P. A., Norfleet R. G., Storer B. E., Surawicz T. S., Marcus P. M. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992 Oct 21;84(20):1572–1575. doi: 10.1093/jnci/84.20.1572. [DOI] [PubMed] [Google Scholar]
  35. Newcomb Polly A., Storer Barry E., Morimoto Libby M., Templeton Allyson, Potter John D. Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer Inst. 2003 Apr 16;95(8):622–625. doi: 10.1093/jnci/95.8.622. [DOI] [PubMed] [Google Scholar]
  36. Niv Y., Lev-El M., Fraser G., Abuksis G., Tamir A. Protective effect of faecal occult blood test screening for colorectal cancer: worse prognosis for screening refusers. Gut. 2002 Jan;50(1):33–37. doi: 10.1136/gut.50.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Northridge M. E., Morabia A., Ganz M. L., Bassett M. T., Gemson D., Andrews H., McCord C. Contribution of smoking to excess mortality in Harlem. Am J Epidemiol. 1998 Feb 1;147(3):250–258. doi: 10.1093/oxfordjournals.aje.a009444. [DOI] [PubMed] [Google Scholar]
  38. O'Connor A. M., Rostom A., Fiset V., Tetroe J., Entwistle V., Llewellyn-Thomas H., Holmes-Rovner M., Barry M., Jones J. Decision aids for patients facing health treatment or screening decisions: systematic review. BMJ. 1999 Sep 18;319(7212):731–734. doi: 10.1136/bmj.319.7212.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Pignone M., Bucholtz D., Harris R. Patient preferences for colon cancer screening. J Gen Intern Med. 1999 Jul;14(7):432–437. doi: 10.1046/j.1525-1497.1999.00018.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Pignone Michael, Saha Somnath, Hoerger Tom, Mandelblatt Jeanne. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2002 Jul 16;137(2):96–104. doi: 10.7326/0003-4819-137-2-200207160-00007. [DOI] [PubMed] [Google Scholar]
  41. Rex D. K., Johnson D. A., Lieberman D. A., Burt R. W., Sonnenberg A. Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology. American College of Gastroenterology. Am J Gastroenterol. 2000 Apr;95(4):868–877. doi: 10.1111/j.1572-0241.2000.02059.x. [DOI] [PubMed] [Google Scholar]
  42. Rex D. K. Men, women, and colorectal cancer: we are winning the battle. Am J Gastroenterol. 1995 May;90(5):840–841. [PubMed] [Google Scholar]
  43. Robert Stephanie A., Strombom Indiana, Trentham-Dietz Amy, Hampton John M., McElroy Jane A., Newcomb Polly A., Remington Patrick L. Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology. 2004 Jul;15(4):442–450. doi: 10.1097/01.ede.0000129512.61698.03. [DOI] [PubMed] [Google Scholar]
  44. Rodwin Victor G., Gusmano Michael K. The World Cities Project: rationale, organization, and design for comparison of megacity health systems. J Urban Health. 2002 Dec;79(4):445–463. doi: 10.1093/jurban/79.4.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Ross Joseph S., Bradley Elizabeth H., Busch Susan H. Use of health care services by lower-income and higher-income uninsured adults. JAMA. 2006 May 3;295(17):2027–2036. doi: 10.1001/jama.295.17.2027. [DOI] [PubMed] [Google Scholar]
  46. Schoenfeld Philip, Cash Brooks, Flood Andrew, Dobhan Richard, Eastone John, Coyle Walter, Kikendall James W., Kim Hyungjin Myra, Weiss David G., Emory Theresa. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med. 2005 May 19;352(20):2061–2068. doi: 10.1056/NEJMoa042990. [DOI] [PubMed] [Google Scholar]
  47. Schoenman Julie A., Berk Marc L., Feldman Jacob J., Singer Andrew. Impact of differential response rates on the quality of data collected in the CTS physician survey. Eval Health Prof. 2003 Mar;26(1):23–42. doi: 10.1177/0163278702250077. [DOI] [PubMed] [Google Scholar]
  48. Seeff Laura C., Manninen Diane L., Dong Fred B., Chattopadhyay Sajal K., Nadel Marion R., Tangka Florence K. L., Molinari Noelle-Angelique M. Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? Gastroenterology. 2004 Dec;127(6):1661–1669. doi: 10.1053/j.gastro.2004.09.052. [DOI] [PubMed] [Google Scholar]
  49. Segnan Nereo, Senore Carlo, Andreoni Bruno, Aste Hugo, Bonelli Luigina, Crosta Cristiano, Ferraris Roberto, Gasperoni Stefano, Penna Angelo, Risio Mauro. Baseline findings of the Italian multicenter randomized controlled trial of "once-only sigmoidoscopy"--SCORE. J Natl Cancer Inst. 2002 Dec 4;94(23):1763–1772. doi: 10.1093/jnci/94.23.1763. [DOI] [PubMed] [Google Scholar]
  50. Selby J. V., Friedman G. D., Quesenberry C. P., Jr, Weiss N. S. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992 Mar 5;326(10):653–657. doi: 10.1056/NEJM199203053261001. [DOI] [PubMed] [Google Scholar]
  51. Selby J. V., Friedman G. D., Quesenberry C. P., Jr, Weiss N. S. Effect of fecal occult blood testing on mortality from colorectal cancer. A case-control study. Ann Intern Med. 1993 Jan 1;118(1):1–6. doi: 10.7326/0003-4819-118-1-199301010-00001. [DOI] [PubMed] [Google Scholar]
  52. Sheinfeld Gorin S., Gemson D., Ashford A., Bloch S., Lantigua R., Ahsan H., Neugut A. Cancer education among primary care physicians in an underserved community. Am J Prev Med. 2000 Jul;19(1):53–58. doi: 10.1016/s0749-3797(00)00153-7. [DOI] [PubMed] [Google Scholar]
  53. Smith R. A., von Eschenbach A. C., Wender R., Levin B., Byers T., Rothenberger D., Brooks D., Creasman W., Cohen C., Runowicz C. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001--testing for early lung cancer detection. CA Cancer J Clin. 2001 Jan-Feb;51(1):38–80. doi: 10.3322/canjclin.51.1.38. [DOI] [PubMed] [Google Scholar]
  54. Subramanian Sujha, Klosterman Michelle, Amonkar Mayur M., Hunt Timothy L. Adherence with colorectal cancer screening guidelines: a review. Prev Med. 2004 May;38(5):536–550. doi: 10.1016/j.ypmed.2003.12.011. [DOI] [PubMed] [Google Scholar]
  55. Sullivan P., Buske L. Results from CMA's huge 1998 physician survey point to a dispirited profession. CMAJ. 1998 Sep 8;159(5):525–528. [PMC free article] [PubMed] [Google Scholar]
  56. Tierney W. M., Hui S. L., McDonald C. J. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Med Care. 1986 Aug;24(8):659–666. doi: 10.1097/00005650-198608000-00001. [DOI] [PubMed] [Google Scholar]
  57. Walsh Judith M. E., Terdiman Jonathan P. Colorectal cancer screening: scientific review. JAMA. 2003 Mar 12;289(10):1288–1296. doi: 10.1001/jama.289.10.1288. [DOI] [PubMed] [Google Scholar]
  58. Winawer S. J., Zauber A. G., Ho M. N., O'Brien M. J., Gottlieb L. S., Sternberg S. S., Waye J. D., Schapiro M., Bond J. H., Panish J. F. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993 Dec 30;329(27):1977–1981. doi: 10.1056/NEJM199312303292701. [DOI] [PubMed] [Google Scholar]
  59. Winawer S. J., Zauber A. G., O'Brien M. J., Ho M. N., Gottlieb L., Sternberg S. S., Waye J. D., Bond J., Schapiro M., Stewart E. T. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993 Apr 1;328(13):901–906. doi: 10.1056/NEJM199304013281301. [DOI] [PubMed] [Google Scholar]
  60. Winickoff R. N., Coltin K. L., Morgan M. M., Buxbaum R. C., Barnett G. O. Improving physician performance through peer comparison feedback. Med Care. 1984 Jun;22(6):527–534. doi: 10.1097/00005650-198406000-00003. [DOI] [PubMed] [Google Scholar]
  61. Zheng Shu, Chen Kun, Liu Xiyong, Ma Xinyuan, Yu Hai, Chen Kang, Yao Kaiyan, Zhou Lun, Wang Linbo, Qiu Peiling. Cluster randomization trial of sequence mass screening for colorectal cancer. Dis Colon Rectum. 2003 Jan;46(1):51–58. doi: 10.1007/s10350-004-6496-2. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES