Researchers said that means rural residents with disabilities may be
at higher risk of getting diagnosed with late-stage cancer than
their urban counterparts.
"Access to care is a real problem. Rural areas have fewer healthcare
providers, especially specialists, and people may have to travel a
long way to get colorectal cancer screening,” said Willi
Horner-Johnson, the study's lead author from Oregon Health and
Science University in Portland. “But I have also been told by
colleagues living in rural areas that there is kind of a ‘tough it
out’ mindset. People don’t want to go to a doctor unless they
absolutely have to," she added.
Colorectal cancer is the second leading cause of cancer-related
deaths in the U.S., according to the Centers for Disease Control and
For people between the ages of 50 and 75, the government-backed U.S.
Preventive Services Task Force recommends screening for colorectal
cancer using one of several methods: colonoscopy every 10 years, a
high-sensitivity fecal occult blood test every year or sigmoidoscopy
every five years in addition to fecal occult blood testing every
Colorectal cancer screening rates have increased in recent years but
the CDC says one in every three adults is still not being screened.
Horner-Johnson told Reuters Health that past studies showed
differences in screening rates between urban and rural dwellers.
She and her team wanted to expand on that research by investigating
how living in a rural community and having a disability might affect
people’s likelihood of being screened.
“We thought that the barriers to screening in rural areas could be
particular hurdles for people who also face barriers related to
their disability,” Horner-Johnson said.
The researchers analyzed survey responses about healthcare use from
more than 11,000 people ages 50 to 64 who reported having any type
of physical disability, hearing or vision loss or limitations in
thinking and memory skills.
They separated the records based on whether respondents lived in a
metropolitan statistical area, as considered by the U.S. Census
Bureau, or outside of one.
Horner-Johnson said the measure of who lived in a city and who did
not was very rough. What’s more, the researchers were only able to
look at whether people had ever been screened, not whether they were
up-to-date with their screening.
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They found that 60 percent of urban residents with disabilities had
been screened for colorectal cancer at least once, compared to 55
percent of rural residents with disabilities.
More of the city residents also had at least a high school
education, private insurance and a family income over the Federal
Poverty Line, the team reports in Disability and Health Journal.
“A number of groups - including the American Cancer Society, the CDC
and state and local public health departments - are doing a lot to
raise awareness of the need for colorectal cancer screening,”
In some of the more rural states, like Oregon and Montana, she
added, those efforts involve a lot of outreach to people with
disabilities in more isolated areas, as well as working with rural
clinics to improve accessibility for people with disabilities.
“Get screened,” Horner-Johnson said. “If you’re age 50 or older and
your doctor hasn’t recommended screening yet, ask about it. If you
have a family history of colorectal cancer, ask if you need to start
screening before age 50.”
She said there is some natural anxiety and embarrassment about the
whole screening procedure, but going through a battle with
colorectal cancer once it’s established is a lot worse.
“More than 50,000 people in the U.S. are expected to die of
colorectal cancer this year. Most of those deaths could be prevented
with timely screening,” Horner-Johnson said.
Disability and Health Journal, online June 17, 2014.
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