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Rural residents with disabilities less likely to get colon cancer screening

By Krystnell Storr

NEW YORK (Reuters Health) - People with disabilities are less likely to get screened for colon and rectal cancer if they live in rural areas, according to a new study.

Researchers said that means rural residents with disabilities may be at higher risk of getting diagnosed with late-stage cancer than their urban counterparts.

"Access to care is a real problem. Rural areas have fewer healthcare providers, especially specialists, and people may have to travel a long way to get colorectal cancer screening,” said Willi Horner-Johnson, the study's lead author from Oregon Health and Science University in Portland. “But I have also been told by colleagues living in rural areas that there is kind of a ‘tough it out’ mindset. People don’t want to go to a doctor unless they absolutely have to," she added.

Colorectal cancer is the second leading cause of cancer-related deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC).

For people between the ages of 50 and 75, the government-backed U.S. Preventive Services Task Force recommends screening for colorectal cancer using one of several methods: colonoscopy every 10 years, a high-sensitivity fecal occult blood test every year or sigmoidoscopy every five years in addition to fecal occult blood testing every three years.

Colorectal cancer screening rates have increased in recent years but the CDC says one in every three adults is still not being screened.

Horner-Johnson told Reuters Health that past studies showed differences in screening rates between urban and rural dwellers.

She and her team wanted to expand on that research by investigating how living in a rural community and having a disability might affect people’s likelihood of being screened.

“We thought that the barriers to screening in rural areas could be particular hurdles for people who also face barriers related to their disability,” Horner-Johnson said.

The researchers analyzed survey responses about healthcare use from more than 11,000 people ages 50 to 64 who reported having any type of physical disability, hearing or vision loss or limitations in thinking and memory skills.

They separated the records based on whether respondents lived in a metropolitan statistical area, as considered by the U.S. Census Bureau, or outside of one.

Horner-Johnson said the measure of who lived in a city and who did not was very rough. What’s more, the researchers were only able to look at whether people had ever been screened, not whether they were up-to-date with their screening.

They found that 60 percent of urban residents with disabilities had been screened for colorectal cancer at least once, compared to 55 percent of rural residents with disabilities.

More of the city residents also had at least a high school education, private insurance and a family income over the Federal Poverty Line, the team reports in Disability and Health Journal.

“A number of groups - including the American Cancer Society, the CDC and state and local public health departments - are doing a lot to raise awareness of the need for colorectal cancer screening,” Horner-Johnson said.

In some of the more rural states, like Oregon and Montana, she added, those efforts involve a lot of outreach to people with disabilities in more isolated areas, as well as working with rural clinics to improve accessibility for people with disabilities.

“Get screened,” Horner-Johnson said. “If you’re age 50 or older and your doctor hasn’t recommended screening yet, ask about it. If you have a family history of colorectal cancer, ask if you need to start screening before age 50.”

She said there is some natural anxiety and embarrassment about the whole screening procedure, but going through a battle with colorectal cancer once it’s established is a lot worse.

“More than 50,000 people in the U.S. are expected to die of colorectal cancer this year. Most of those deaths could be prevented with timely screening,” Horner-Johnson said.

SOURCE: http://bit.ly/1zaE4DL Disability and Health Journal, online June 17, 2014.

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