Evaluation of Colonoscopy and Sigmoidoscopy Utilization for Colorectal Cancer Screening in Georgia, USA

Abstract

Colorectal cancer (CRC) is the third most prevalent cancer, and the second most common cancer-related cause of death in the United States (USA). Timely screening reduces both CRC incidence and mortality. Understanding population behaviors and factors that influence CRC screening is important for directing interventions targeted at reducing CRC rates. The 1997–2018 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for trends in colonoscopy and sigmoidoscopy utilization for CRC screening among adults in Georgia, USA. Overall, in Georgia, there has been an increase in the prevalence of colonoscopy and sigmoidoscopy utilization from 48.1% in 1997 to 71.2% in 2018 (AAPC = 2.30, p < 0.001). Compared nationally, this increase was less pronounced (from 41.0% in 1997 to 73.7% in 2018 (AAPC = 2.90, p < 0.001) overall for USA). Logistic regression analysis of the 2018 BRFSS data, adjusting for sociodemographic factors, shows that sex (female vs. male [aOR = 1.20, C.I. = 1.05, 1.38]); marital status (couple vs. single [aOR = 1.20, C.I. = 1.04, 1.39]); healthcare coverage (yes vs. no [aOR = 3.86, C.I. = 3.05, 4.88]); age (60–69 years [aOR = 2.38, C.I. = 2.02, 2.80], 70–79 [aOR = 2.88, C.I. = 2.38, 3.48] vs. 50–59 years); education (high school [aOR = 1.32, C.I. = 1.05, 1.65], some post high school [aOR= 1.63, C.I. = 1.29, 2.06], college graduate [aOR = 2.08, C.I. = 1.64, 2.63] vs. less than high school); and income ($25,000–$49,999 [aOR = 1.24, C.I. = 1.01, 1.51], $50,000+ [aOR = 1.56, C.I. = 1.27, 1.91] vs. <$25,000) were all significantly associated with colonoscopy and sigmoidoscopy utilization. In Georgia, a significant increase over time in colonoscopy and sigmoidoscopy utilization for CRC screening was observed pertaining to the associated sociodemographic factors. The findings from this study may help guide tailored programs for promoting screening among underserved populations.

County‐level colorectal cancer screening rates on colorectal cancer survival in the state of Georgia: Does county‐level rurality matter?

“…Regular CRC screening with either a high‐sensitivity stool‐based test or a visualization test (e.g., colonoscopy or sigmoidoscopy) are recommended for screening eligible individuals 5 . In Georgia, there was an increase in the utilization of colonoscopy or sigmoidoscopy for CRC screening between 1997 and 2018, with rates increasing from 48.1% to 71.2% 3 . Despite these improved rates, screening use in Georgia is still behind the national goals 6 …”

“…Despite this higher burden in mortality, there has been an average reduction in annual mortality rate of 2.3% per year during the period from 2002 to 2013 1 . Systematic CRC screening efforts and better treatment have contributed to these reduced trends in Georgia 3 . According to the U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) recommendations on CRC screening, average‐risk individuals should have routine screening to reduce CRC mortality 4,5 .…”

“…5 In Georgia, there was an increase in the utilization of colonoscopy or sigmoidoscopy for CRC screening between 1997 and 2018, with rates increasing from 48.1% to 71.2%. 3 Despite these improved rates, screening use in Georgia is still behind the national goals. 6 While CRC mortality has improved over time, these improvements have not been equally distributed across different geographic areas.…”

“…1 Systematic CRC screening efforts and better treatment have contributed to these reduced trends in Georgia. 3 According to the U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) recommendations on CRC screening, average‐risk individuals should have routine screening to reduce CRC mortality. 4 , 5 Regular CRC screening with either a high‐sensitivity stool‐based test or a visualization test (e.g., colonoscopy or sigmoidoscopy) are recommended for screening eligible individuals.…”

“… 5 In Georgia, there was an increase in the utilization of colonoscopy or sigmoidoscopy for CRC screening between 1997 and 2018, with rates increasing from 48.1% to 71.2%. 3 Despite these improved rates, screening use in Georgia is still behind the national goals. 6 …”