title: Longitudinal Rates of Colon Cancer Screening Use in Winnipeg, Canada: The Experience of a Universal Health-Care System with an Organized Colon Screening Program.
abstract: OBJECTIVE
  We examined trends in colorectal cancer (CRC) screening (fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy (FS)) and differences in CRC screening by income in a population with an organized CRC screening program and universal health-care coverage.
  
  
  METHODS
  Individuals who had an FOBT, colonoscopy, or FS were identified from the provincial Physician Claims database and the population-based colon cancer screening registry. Trends in age-standardized rates were determined. Logistic regression was performed to explore the association between CRC screening and income quintiles by year.
  
  
  RESULTS
  Up-to-date CRC screening (FOBT, colonoscopy, or FS) increased over time for men and women, all age groups, and all income quintiles. Up-to-date CRC screening was very high among 65- to 69- and 70- to 74-year-olds (70% and 73%, respectively). There was a shift toward the use of an FOBT for CRC screening for individuals in the lower income quintiles. The disparity in colonoscopy/FS coverage by income quintile was greater in 2012 than in 1995. Overall, there was no reduction in disparities by income in up-to-date CRC screening nor did the rate of increase in up-to-date CRC screening or FOBT use change after the introduction of the organized provincial CRC screening program.
  
  
  CONCLUSIONS
  CRC screening is increasing over time for both men and women and all age groups. However, a disparity in up-to-date CRC screening by income persisted even with an organized CRC screening program in a universal health-care setting.
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.|Screening Programs, CancerCare Manitoba, Winnipeg, Manitoba, Canada.|Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Decker
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Alain A
authors.initials: AA
authors.lastname: Demers
authors.affiliation: Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada.|Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Zoann
authors.initials: Z
authors.lastname: Nugent
authors.affiliation: Screening Programs, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Biswanger
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.|Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.|Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D019472:Universal Health Insurance / Q000706:statistics & numerical data