title: Surveillance after resection for colorectal cancer.
abstract: BACKGROUND
  Professional societies recommend posttreatment surveillance for colorectal cancer (CRC) survivors. This study describes the use of surveillance over time, with a particular focus on racial/ethnic disparities, and also examines the role of area characteristics, such as capacity for CRC screening, on surveillance.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to identify individuals aged 66 to 85 years who were diagnosed with CRC from 1993 to 2005 and treated with surgery. The study examined factors associated with subsequent receipt of a colonoscopy, carcinoembryonic antigen (CEA) testing, primary care (PC) visits, and a composite measure of overall surveillance.
  
  
  RESULTS
  Of eligible subjects, 61.0% had a colonoscopy, 68.0% had CEA testing, 77.1% had PC visits, and 43.0% received overall surveillance. After adjustment, blacks were less likely than whites to undergo colonoscopy (odds ratio [OR] 0.76, 95% confidence interval [CI] = 0.69-0.83) and to receive CEA testing and overall surveillance, whereas white/Hispanic rates did not differ. Rates for all outcomes increased from 1993 to 2005, but black/white disparities remained. Individuals in areas with greatest capacity for CRC screening were more likely (OR = 1.09, 95% CI = 1.02-1.18) to receive colonoscopy, and those in areas with the greatest percentage of blacks were less likely (OR = 0.89, 95% CI = 0.83-0.95) to receive colonoscopy. Those living in areas with shortage of PC were less likely to receive PC visits (OR = 0.55, 95% CI = 0.48-0.64) and overall surveillance (OR = 0.83, 95% CI = 0.71-0.98).
  
  
  CONCLUSIONS
  Many CRC survivors do not get recommended surveillance, and black/white disparities in rates of surveillance have not improved. Characteristics of the area where an individual lives contribute to the use of surveillance.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02120-1613, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Brawarsky
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.forename: Craig
authors.initials: C
authors.lastname: Earle
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D017741:Survivors; D044465:White People
chemical_list: D002272:Carcinoembryonic Antigen