title: Barriers to colorectal cancer screening among Medicare consumers.
abstract: BACKGROUND
  Few studies have examined lack of physician recommendation and other reasons for under-utilization of colorectal cancer (CRC) screening in the Medicare population.
  
  
  METHODS
  Data from a telephone survey conducted in 2001 in a random sample of Medicare consumers residing in North and South Carolina were used to examine barriers to CRC screening, focusing on consumers' reports of receiving a physician's recommendation to obtain CRC screening and reasons for not being screened. Analyses were restricted to respondents with no history of CRC (n = 1901). Descriptive statistics were used to characterize respondents' CRC screening status, receipt of a physician's recommendation for screening, and reasons for not being screened. Logistic regression modeling was used to examine factors associated with receiving a physician recommendation for fecal occult blood test, sigmoidoscopy, colonoscopy, any endoscopy, and any CRC test.
  
  
  RESULTS
  Thirty-one percent of Medicare consumers had never been tested for CRC, and 18% had been tested but were not current with Medicare-covered intervals. Overall, 28% reported not receiving a physician recommendation for screening. Predictors of receiving a physician recommendation included sociodemographic (younger age, white race, more education), health status (increased CRC risk, comorbidity), and healthcare access (had a routine/preventive care visit in the past 12 months) factors. Lack of knowledge/awareness and the physician not ordering the test were commonly cited reasons for not having CRC tests.
  
  
  CONCLUSIONS
  Colorectal cancer screening was under-utilized by Medicare consumers in two states, and lack of physician recommendation was an important contributing factor. Providing a benefit under the Medicare program does not ensure its widespread use by consumers or their physicians.
authors.affiliation: Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Anna P
authors.initials: AP
authors.lastname: Schenck
authors.forename: William W
authors.initials: WW
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D003144:Communication Barriers; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D006801:Humans; D008297:Male; D008403:Mass Screening; D006278:Medicare; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009780:Occult Blood; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D020694:Sigmoidoscopes / Q000706:statistics & numerical data; D013022:South Carolina / Q000453:epidemiology