Colorectal cancer (CRC) is the second leading cause of cancer-related death, overall. Among men, prostrate cancer is third leading cause, and among women, breast cancer is the second leading cause of cancer death. Racial disparity in deaths due to these cancers occur, with black men having higher mortality from prostrate cancer than whites and black women having higher CRC and breast cancer mortality than white women. Although CRC screening reduces mortality, it is underused: in 1999, according to the BRFSS, only 20.6 percent reported fecal occult blood screening (FOBT) within the last year and 33.6 percent reported flexible sigmoidoscopy (FS) within the last five years. The Healthy People 2000 goals of 50 percent for FOBT and 40 percent for FS were not met. Breast cancer screening has reached Healthy People 2000 goals overall, but screening among minority and low income women are lower than goals. Primary care physicians are expected to provide a variety of preventive services such as cancer screening and immunizations, in an environment affected by time constraints, frequency of patient visits, changing recommendations and other factors including patient perception of risk, etc. How is cancer screening identified in medical charts and affected by behavioral and other factors (based on survey data) of the patient, provider and system? How does the provision of other preventive services especially cancer screening relate to immunization? The investigators were funded by an AHRQ R01 award to study barriers and facilitators to adult vaccination. Four strata were sampled: 1) inner-city health centers; 2) Veterans Affairs [VA] clinics; 3) rural; and 4) suburban practices. Use of inner-city practices allows the issues of disparity based on poverty or race to be addressed. The VA has implemented interventions to increase provision of preventive services. For the R01, the investigators conducted medical record reviews (n=810) and clinician, and patient (n = 1007) interviews about adult immunizations, with some cancer screening data. An ATPM-CDC grant allowed collection of similar data in an additional 200 patients. Neither grants included analysis of cancer screening. The investigators propose to: 1) quantify, the CRC, prostate and breast cancer screening rates by demographic and other patient factors; 2) determine main predictors of screening in multivariable analyses; 3) correlate with rates of other preventive services; and 4) identify behavioral factors (based on surveys) affecting screening such as social influences, communication with doctor, access, health habits and status. Without understanding the barriers to prevention from multiple vantage points, the rates of preventive services are unlikely to reach 2010 goals and needless cancer deaths will occur.
