Elucidating the Barriers to Colorectal Cancer Screening in a Rural Population

Abstract

Background

The incidence of colorectal cancer (CRC) has increased steadily in the last decade in the United States and is one of the leading causes of death. However, screening rates for colorectal cancer continue to remain at an all-time low in the United States and worldwide. Cancer screening programs can effectively reduce the burden of cancer when designed properly to ensure compliance and efficacy. The principal challenges in optimizing the delivery of effective cancer screening services and reducing inappropriate testing are predicated on (1) recognizing the main barriers preventing the delivery of life-preserving cancer screening available to eligible and vulnerable populations; (2) changing the behaviors of health care providers to follow recommended cancer screening guidelines for all patient encounters; and (3) changing the behaviors of individuals to obtain recommended screening education, tests and pursue follow-up.

Methodology

Surveys were distributed at various cancer screening events. The questionnaire was one page long and focused on the question: "What barriers do you experience with cancer screening? Please mark all that apply:" The barriers to cancer screening listed on the questionnaire were: embarrassment, unpleasantness of test, transportation, cost/lack of insurance, fear of results, lack of symptoms, lack of physician recommendations, lack of awareness, language barriers, and other causes. The questionnaire also recorded patient demographics including age, gender, and race.

Results

A total of 194 patients responded to our survey. 122 (62.9%) females, 71 males (36.6 %) and one did not specify. Genders were generally equally represented among all races. The ages ranged from 13 to 86 years with a mean of 51.79 and a standard deviation of 13.5. The overwhelmingly main barrier for screening was lack of funding or insurance (66%).

Conclusion

Given low screening rates for CRC, collaborative efforts should be made to remind more patients and have close follow up with their primary care physicians. Multilevel interventions can help address these barriers in preventing this deadly disease.