Socioeconomic Disparities in Participation in Organized Cancer Screening Programs

Summary and Comment |
February 10, 2017

Socioeconomic Disparities in Participation in Organized Cancer Screening Programs

  1. Douglas K. Rex, MD

Data from organized programs around the world show lower participation in lower socioeconomic strata.

  1. Douglas K. Rex, MD

Programmatic, or organized, cancer screening refers to a systematic screening effort that is typically organized at a national level, or, as in the U.S., by a large healthcare system (e.g., Kaiser Permanente). These programs are typically based on fecal occult blood testing (FOBT). Most screening in the U.S. is opportunistic, meaning that it results from a physician–patient interaction. Although the U.S. has the world's highest screening participation rates, organized screening is generally considered a superior approach to opportunistic screening.

In this study, researchers assessed socioeconomic disparities in participation in organized colorectal screening programs. They surveyed 24 organized, FOBT-based screening programs worldwide and reviewed relevant publications. Eleven programs collected data on participation by socioeconomic status (SES), analyses of which were available in 23 publications. Lower SES was associated with lower participation in 28 of 31 unique findings published, which included SES measures of income level, economic burden of testing, quality of medical insurance, and education level. Differences in screening rates were as high as 26% between groups in the highest and lowest SES categories.

Comment

These results suggest that disparities in screening participation occur in organized as well as opportunistic screening. In the U.S., lower participation is associated with lower socioeconomic status and African-American race. Constant vigilance is needed to try to optimize screening rates in these groups.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Covidien; Olympus Corporation America; Endo-Aid Ltd.; Endochoice; Boston Scientific; Paion AG; Ironwood Pharmaceuticals; Colonary Solutions; Novo Nordisk Inc.; Medscape Gastroenterology Grant / Research support: Braintree Laboratories Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology (associate editor); GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

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