title: Colorectal cancer screening in an equal access healthcare system.
abstract: BACKGROUND
  The military health system (MHS) a unique setting to analyze implementation programs as well as outcomes for colorectal cancer (CRC). Here we look at the efficacy of different CRC screening methods, attributes and results within the MHS, and current barriers to increase compliance.
  
  
  METHODS
  A literature search was conducted utilizing PubMed and the Cochrane library. Key-word combinations included colorectal cancer screening, racial disparity, risk factors, colorectal cancer, screening modalities, and randomized control trials. Directed searches were also performed of embedded references.
  
  
  RESULTS
  Despite screening guidelines from several national organizations, extensive barriers to widespread screening remain, especially for minority populations. These barriers are diverse, ranging from education and access problems to personal beliefs. Screening rates in MHS have been reported to be generally higher at 71% compared to national averages of 50-65%.
  
  
  CONCLUSIONS
  CRC screening can be highly effective at improving detection of both pre-malignant and early cancers. Improved patient education and directed efforts are needed to improve CRC screening both nationally and within the MHS.
authors: Department of Surgery, Madigan Healthcare System, Tacoma, Washington, USA.
authors: Mia
authors: M
authors: Debarros
authors: Scott R
authors: SR
authors: Steele
keywords: FOBT.; VA; colonoscopy; colorectal cancer; flexible sigmoidoscopy; military healthcare system; screening